New-onset anosmia and taste distortion: see beyond COVID-19
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COVID-19
New-onset anosmia and taste distortion: see beyond COVID-19 Sara Casciato 1 & Sergio Paolini 1 & Giancarlo Di Gennaro 1 Received: 19 August 2020 / Accepted: 10 October 2020 # Fondazione Società Italiana di Neurologia 2020
Dear Editor, We have read carefully the very interesting article titled “The neurological manifestations of Covid-19: a review article” by Niazkar et al. [1], recently published on your Journal. The Authors reviewed neurological signs and symptoms due to SARS-CoV 2 infection categorized in central nervous system (CNS) and peripheral nervous system (PNS) associated ones. Anosmia and ageusia are the most common PNS manifestation of COVID-19 occurring suddenly and usually with fewer nasal symptoms, such as nasal obstruction or excessive nasal secretion. Recently, Patel et al. [2] investigated the prevalence of anosmia and ageusia in 141 adult patients with a laboratory-confirmed diagnosis of infection with severe acute respiratory distress syndrome coronavirus-2 (SARS-CoV-2). They found that more than half of positive patients reported anosmia and ageusia, thus suggesting that they should be added to the case definition and used to guide self-isolation protocols. Mild community-treated patients were more likely to report anosmia than those admitted to hospital. This evidence supports emerging data associating new-onset anosmia with mild or absent other COVID-19 symptoms [3]. Anosmia can result from many underlying diseases. The most common causes are sinonasal diseases and postinfectious and post-traumatic disorders. Other etiologies (e.g., congenital, idiopathic, toxic disorders, or disorders caused by a neurodegenerative disease) are less common but nonetheless important to rule out [4]. Unfortunately, the COVID-19 pandemic deeply impacted on the management of acute and chronic neurological conditions. Non-urgent surgical procedures, medical appointments, and diagnostic tests
* Giancarlo Di Gennaro [email protected] 1
IRCCS NEUROMED, Pozzilli, (IS), Italy
have been cancelled to increase bed capacity and care for patients with the infection [5]. In the dramatic context of the COVID-19 outbreak in Italy, a 44-year-old female has been referred us for new-onset anosmia and taste distortion (“I badly distinguish flavors, the food had little taste”), associated to headache not responsive to common analgesic, gradually developed in a couple of weeks. During a previous consultation, as the symptoms were not accompanied by fever or cough, it has been hypothesized that the anosmia and the taste dysfunction could have a functional origin rather that organic, probably unconsciously shaped on the peculiar COVID-19 clinical picture, heavily disseminated by the media and information organs. Neurological examination was unremarkable with the exception of complete anosmia and mild dysgeusia. Despite the difficulties in performing diagnostic tests due to the pandemic, a brain MRI scan was obtained and showed a large, contrastenhancing space-occupying lesion compatible with an olfactory groove meni
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