COVID-19-induced anosmia associated with olfactory bulb atrophy
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SHORT REPORT
COVID-19-induced anosmia associated with olfactory bulb atrophy Andrew Chiu 1
&
Nancy Fischbein 1 & Max Wintermark 1 & Greg Zaharchuk 1 & Paul T. Yun 2 & Michael Zeineh 1
Received: 9 July 2020 / Accepted: 9 September 2020 # Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract As the global COVID-19 pandemic evolves, our knowledge of the respiratory and non-respiratory symptoms continues to grow. One such symptom, anosmia, may be a neurologic marker of coronavirus infection and the initial presentation of infected patients. Because this symptom is not routinely investigated by imaging, there is conflicting literature on neuroimaging abnormalities related to COVID-19-related anosmia. We present a novel case of COVID-19 anosmia with definitive olfactory bulb atrophy compared with pre-COVID imaging. The patient had prior MR imaging related to a history of prolactinoma that provided baseline volumes of her olfactory bulbs. After a positive diagnosis of COVID-19 and approximately 2 months duration of anosmia, an MRI was performed that showed clear interval olfactory bulb atrophy. This diagnostic finding is of prognostic importance and indicates that the olfactory entry point to the brain should be further investigated to improve our understanding of COVID infectious pathophysiology. Keywords COVID-19 . Anosmia . Olfactory bulb
Main text Although hyposmia or anosmia has been reported in as many as 60% of patients who are symptomatic with COVID-19, imaging of the olfactory nerve is not routinely employed. The olfactory nerve is small and only well seen on dedicated
* Andrew Chiu [email protected] Nancy Fischbein [email protected] Max Wintermark [email protected] Greg Zaharchuk [email protected] Paul T. Yun [email protected] Michael Zeineh [email protected] 1
Division of Neuroradiology, Department of Radiology, Stanford University, 300 Pasteur Drive, Room S047, Stanford, CA 94305-5105, USA
2
Menlo Medical Clinic Stanford HealthCare, 321 Middlefield Road, 1st Floor, Menlo Park, CA 94205, USA
skull base magnetic resonance imaging (MRI), so prospective assessments of its changes have been lacking. We present a case of a COVID-19 patient with anosmia showing atrophy of the olfactory bulbs by MRI in comparison with a presymptomatic MRI obtained for an unrelated cause. A 19-year-old female presented to the otolaryngologist with persistent anosmia after a RT-PCR and serological confirmed diagnosis of COVID-19 1 month prior. At the time of presentation, the patient had a negative RT-PCR and resolution of COVID-19-related respiratory symptoms, but had not recovered her sense of olfaction. The patient underwent a skull base MRI, approximately 2 months after the onset of anosmia. Because of a history of prolactinoma treated medically, the patient had multiple prior MRIs over the course of 4 years. Compared with these multiple prior MRIs, visual and quantitative assessment of a coronal T2 fat-suppressed sequence through the anterior cranial fossa showed new bilateral atrophy of
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