Disorders of Smell, Taste, and Food Intake in a Patient With a Dorsomedial Thalamic Infarct. M. Rousseaux;,; P. . Fruits, recall, 7, Fruits, recognition, The romantic notion that babies smell like butter and clouds goes right out If you get a little bit of hair when you're 9, 10, 11, that's one thing. neuropil called glomeruli [9,10]. There, the ORN afferents synapse onto second- order projection neurons (which are like the mitral cells of vertebrates); most.
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From its entrance into the brainstem, all the gustatory fibers are narrowed to the solitary tract and eventually make synapses in the rostral part of the nucleus of the solitary tract.
After this point, the axons rostrally pass by barely defined ways towards the ventromedial nucleus of the thalamus and then towards the cerebral cortex in the central area of the post-central gyrus, which is rolled into the lateral fissure Etiology A range of nosologic entities occur along with smell and taste alterations, which can be congenital or acquired, and the ones mostly mentioned in literature are: The taste and smell abnormalities are proven to be an extremely more complex subject than previously considered and they are also present in situations such as deficits of vitamins B6, B12, A and zinc or copper, tabagism, pregnancy, general anesthesia, dental traumas, arhinencephaly and nasal septum deviations The obstruction is the most common cause of olfactory disorder.
If the obstruction is complete, the individual shows an anosmia smell molecules do not reach the olfactory epithelium , releasing the obstruction and the olfactory ability is returned. The anteromedial part of the inferior part of the medium turbinate bone works as a regulator of the air flow to the olfactory area.
An obstruction in this critical area by mucosa edema, polyps, tumors, bone abnormalities, surgeries between the medium turbinate bone and the nasal septum or trauma can reduce or eliminate the olfactory ability. This can also happen when the inferior cavity looks normal. It can occur in any age group, prevalently in women. The patients usually mention a progressive and gradual loss of floating smell, and acute losses can occur with acute infections and exposure to allergens 12, The upper airway infections are also one of the main causes of olfactory loss.
In some cases, smell does not return to normal. At the biopsy, a metaplasia can happen with a reduction or absence of olfactory receivers and a replacement for a respiratory epithelium in some cases. The olfactory loss is proportional to the neuronal loss and the prognosis is poor. One third spontaneously recovers with or without a treatment, and hyposmia occurs more frequently than anosmia. Phantosmia rarely occurs sense of a smell which is not real 16, 17, Cranioencephalic trauma can damage the olfactory nerves in the cribriform lamina because of the coup or countercoup powers.
Generally speaking, the loss degree is associated with the trauma severity, what does not mean that a minimum trauma cannot be associated with anosmia.
The start of loss is usually immediate, but some patients only notice it after some months. When smell is partially preserved, a reduction in the distinction of smells has been noticed The exact cause has not been determined. The most popular theory assumes a lesion of the nerves when they leave the top of the cribriform lamina.
The lesion can happen in the frontal cortex, because, in addition to post-TCE anosmia, some patients show psychosocial alterations. The computed tomography is usually normal, and in some cases it can show a fracture in the cribriform lamina.
Hyposmia occurs mostly in frontal lesions; anosmia in occipital lesions, five times more frequent. The elderly have a higher ratio of smelling reduction for some smells than others, showing a reduction in the ability to distinguish the taste of everyday food. This olfactory reduction is due to either the physiological process of aging presbyosmia , occurring in the sixth or seventh decade, or to Alzheimer and Parkinson diseases The olfactory dysfunction is one of the most prevalent signs in the Parkinson disease.
Alterations in olfactory discrimination, identification and threshold are observed. Hyposmia is one of the signals that can precede the motor signals of the pathology. It is usually an isolated finding, but there is a familiar anosmia associated with a premature baldness and vascular headache, and it is hereditary, dominant with a variable penetration. It is caused by a defect in the migration of the neurons producing the gonadotropin-releasing hormones GnRH and the neurons composing the olfactory nerves.
Anosmia is related to the deficit of GnRH because the migration and the differentiation of the secretory neurons of GnRH depend on the formation of the olfactory bulb. The impaired individuals do not understand the idea of smell; therefore, they do not miss it. Due to the fact some chemical receivers still remain intact, bitter, irritating smells and tastes can be normally detected 24, When there is an exposure of the olfactory system to toxic substances, the olfactory loss can occur in days or years, and it can be reversible or permanent.
The lesion degree seems to be related to the time of exposure and the concentration and toxicity of the agent, commonly associated with tobacco. Examples of olfactory-impairing drugs are: Amphetamine, antibiotics aminoglycosides, tetracycline , cocaine, petroleum-derived, sulfur dioxide, ethanol, formaldehyde, heavy metals, methanol, carbon monoxide, nicotine, organic solvents, zinc sulfate topic and carbon tetrachloride 12, The drugs usually attack taste more than smell.
In most cases, smell is returned when drugs are suspended, but there are reports about a permanent lesion. Drugs attacking the composition of the mucus can change olfaction, such as beta-adrenergic, cholinergic and peptidergic agents. The neoplasic processes also deserve an attention, emphasizing those of intranasal location, such as nasal polyps, papilloma, epidermoid carcinoma, adenoma, esthesioneuroblastoma rare neuro-olfactory tumor , because they block the air flow for the olfactory cleft or due to a local destruction of the olfactory system The intracranial neuroplasias involving the orbital surface of the brain can cause unilateral anosmia.
Meningiomas of either the sphenoid ridge or the olfactory sulci, as well as gliomas of the frontal lobe, can cause lesion on thee bulbs or olfactory tracts. Anosmia can also occur in association with other tumors of the frontal lobe and parasellar and hypophyseal lesions. In meningiomas of the olfactory sulcus or of the area of the cribriform lamina, unilateral anosmia occurs early and evolves into bilateral anosmia together with the frequency of optical neuropathy.
Foster Kennedy's syndrome consists in anosmia together with unilateral ipsilateral optic atrophy and contralateral papilledema derived from a big tumor involving the orbitofrontal area Some psychiatric pathologies occur simultaneously with smell disorders. Patients showing a bigger depression can show the same symptom, but they usually have a preserved olfactory ability.
Phantosmia can be shown as an aura in patients with epilepsy of the temporal lobe 15, Iatrogenic cannot be unmentioned as a relevant etiologic factor. In surgical procedures, a neural damage and a narrowing of the nasal flow can occur due to anatomic alterations or cicatricial tissue. Alterations in the smell and taste occur after total laryngectomy, because the patients start breathing directly through the trachea and the air does not pass through the nose to the terminal olfactory organs.
As smell and taste are closely linked, sensations of taste are changed. Yet, through time, the patient usually gets used to this problem, what can justify the fact that not all patients mention an olfactory alteration In surgeries of the anterior fossa and post-transsphenoidal neurosurgery, cribriform lamina lesion can occur.
Radiotherapy is also included in the group of conditions leading to smell and taste dysfunctions, as well as those with idiopathic causes, usually in young adults, in middle age and healthy individuals 12, In leprosy, the olfactory alterations can be found in any form of the disease. Besides, it is a common complaint in this pathology and it can be mostly found in the lepromatous form, and it is reported that this impairment is associated with the severity of the clinical alterations in the nasal mucosa.
In a study performed in , the findings of olfactory alterations were obtained in four different forms of leprosy; however such findings were obtained in patients at an advanced stage or in reaction. Hyposmia was found in 7. A few cases of olfactory disorders have a neurological background. Multiple sclerosis can cause olfactory alterations due to involving the olfactory areas. Several neurological conditions causing anosmia include hydrocephaly, impairment of the anterior cerebral artery near its origin, basilar meningitis, abscesses of the frontal lobe and Refsum's disease.
Temporal lobectomies including the piriform cortex can cause deficits in smell identifications Hyperosmia is usually functional, but it can occur in certain types of drug abuse and migraine. Olfactory hallucinations are mostly due to psychosis, but they can as well derive from a lesion in the central olfactory system, usually neoplasic or vascular, or as a manifestation of convulsive crisis.
The so-called uncinate crises are partial complex crises of the temporal lobe preceded by an usually unpleasant olfactory or gustatory atmosphere, and they are often accompanied, whereas the patient loses the conscience of lip-cracking and chewing movements. These attacks are usually derived from a convulsive focus involving structures of the medial temporal lobe The taste can be attacked in cases of lesions of the facial nerve near the exit of the tympanic cord.
However, in the case of permanent gustatory disorders, these can survive after Bell's facial palsy. Dysfunctions in the taste and smell usually occur together, because the abnormalities of the taste usually result from the olfactory dysfunction.
Dysgeusia can be a direct or indirect effect of malign conditions. Hypergeusia and parageusia can occur in psychoses and in the conversion disorder Gustatory hallucinations can occur in partial complex crises and in tumors involving the uncus and the parietal operculum and they often occur together with olfactory hallucinations.
Elderly patients sometimes develop obscurely originated dysgeusia that can cause anorexia and loss of weight. The increased gustatory sensitivity occurs in patients having Addison's disease, pituitary deficits and cystic fibrosis.
Lesions in the lingual nerve can cause a loss of palate together with the loss of exteroceptive sensation of the affected side of the tongue Diagnostic Methods The evaluation of the olfactory alterations can be made by introducing smells cinnamon, turpentine, lemon, smoke, chocolate, rose, paint solvent, banana, pineapple, gasoline, soap, onion.
Each nostril must be separately explored, and the patient is inquired about the type of smell 21, Microscopy or endoscopy can define alterations in the air flow as a cause of anosmia The nasal endoscopy is useful to access the olfactory ridge, and it is in association with the computed tomography, the most sensitive ways to diagnose pathologies derived from the nasal cavity, paranasal sinus and encephalon.
Rhinometry shows a little diagnostic value, and it is valid only to demonstrate the reductions in the respiratory flow. The nuclear magnetic resonance is useful to evaluate the olfactory bulb, olfactory tracts and intracranial causes of olfactory disorders TSUKATANI et al in demonstrated that these tests agree with each other when evaluating whether an olfactory dysfunction is absent or present; however, the tests disagree when evaluating the levels of hyposmia In the detection tests, a lower smelling concentration capable of being detected is pursued.
They are performed to provide the patient with two or more stimuli, only one of which has a smelling substance. This type of investigation proved to be more effective than simply asking whether a smell can or cannot be felt In the recognition tests, a lower concentration of the smell capable of being recognized is pursued, and the most used method is the ascending threshold one. In this test, smells are sequentially presented from the lowest to the highest concentration and it is estimated the point of smell recognition It is a simple and rapidly performed method, and it eliminates the risk of contaminating the examiner's hand and the patient by the smell.
Nevertheless, there is an intense release of the smell when the diskette is open, and it is therefore a suprathreshold test, functioning as a screening The following items are analyzed: Other exams can help diagnose olfactory dysfunction, such as: Single-Photon Emission Computed Tomography SPECT , olfactory-pupilary reflex olfactory-tensional or cardiovascular reflex, cutaneous or psychogalvanic reflex, olfactory-respiratory reflex, electro-olfactogram and the evoked potential of the olfactory nerve 4.
A detailed anamnesis is also important to diagnose the taste alterations. In some situations, help from other specialists is necessary, such as endocrinologist and geneticist, to better clarify the diagnosis.
Solution-solved papers with different concentrations of glucose, salt, acid, etc. Treatment Many simple ideas can be suggested to patients with taste alterations. Chewing gum or ice can work as a temporary help in hypogeusia. The patients must be encouraged to chew their food very well, changing the sides of the mouth or their foods Disorders in chemical sensitivity, smell and taste are symptoms of diseases; hence the treatment depends on their cause.
Smell discrimination and identification scores in Thai adults with normosmia
Taste sensation results from the association between gustatory, olfactory and somatosensory information (9, 10). Smell In men, smell is probably the least. To prevent flavor/odor defects in milk, proper milk handling procedures from the .. should reflect the overall acceptability of the milk as follows: Excellent. 9 - WebMD provides ideas for games to play with baby to help his or her developing senses.