ANOSMIA, CACOSMIA AND DYSGEUSIA, WITH
PRECEDING BENIGN POSITIONAL PAROXYSMAL VERTIGO, IN A WOMAN TREATED WITH
ANTIDEPRESSANT AND ANTISTRESS DRUG THERAPY.
Renato COCCHI, a neurologist and a medical
psychologist.
(Ten other texts about smell troubles)
Summary.
The text reports a new case of anosmia,
cacosmia and dysgeusia in a woman aged 48, which started six months before with
headache and benign positional paroxysmal vertigo, treated with rehabilitative
vestibular therapy. The woman had depressive symptoms, and referred some
oversensitiveness to smell, lasting many years. The antidepressant and
antistress, after eleven months, reduced the cacosmia, the dysgeusia and
perhaps even the anosmia.
Key words: Cacosmia, dysgeusia, anosmia,
stress, depression, BPPV, drug therapy.
Drug modulation of stress answers
This new case of smell and taste trouble that
will be reported as it follows has a particular characteristic. It started with
headache and an episode of benign positional paroxysmal vertigo (BPPV) treated
by vestibular rehabilitation, but I do not know if this is meaningful,
As for the smell troubles, Gil-Carcedo,
Gil-Carcedo, Vallejo and Ortega, 1999, wrote about three main groups according
with the site of the causal lesion: conduction, sensorineural, and mixed
anosmias. In addition, within the sensorineural anosmias, they distinguish
between the epithelial, retroepithelial, and central anosmias. Chemosensory
dysfunction is most often secondary to one of only a few causes: nasal/sinus
disease, viral infection, toxic chemical exposure, head trauma, as well as
medication-related and idiopathic conditions.
The case history.
A woman of 48 years, working in the public
health. From a year she suffers from troubles of the sense of smell and of
taste.
End December 2004, the first examination for
cacosmia and dysgeusia. By intentionally questioned, in facts there is even a
clear anosmia, to which the patient seems not to give much weight, perhaps for
the disability prominence of the other two symptoms. She has these sensory
altered perceptions since one year. The trouble appeared in a period of severe
stress and it appeared together an episode of objective vertigo, benign
positional paroxysmal vertigo, treated positively with vestibular
rehabilitation therapy. She has always been a little sensitive to the odours,
or to certain odours, a fact that was increased, as nearly a hyperosmia, when
she was is emotionally excited.
Differently from other cases, she did not
have any increase of olfactory sensitivity during the pre- and menstrual
period. After six months if the vertigo episode, she became hyperosmic then
unexpectedly cacosmia and dysgeusia came out. Now, she bears badly the smoke of
cigarettes and the exhausted gas of the cars. It is the same for coffee and
chocolate, as for the taste. Usually she eats fewer yields and vegetable.
Currently there is not a hyperosmic phase, but all odours reduced or not
perceived.
Depression: She is depressed, and she thinks that her depression
has a reactive origin. She was always a person emotionally much sensitive.
Never she was hyperactive, but on the contrary she fought against her idleness.
As a child she did not easily to do friendship. On the work she is not
obsessive. To the test " Which is the opposite of the colour Red?"
she answers: Yellow. In the morning she feels worse. Now she doesn't sleep well
and inclines to wake early, but she is well falling asleep. She has
tachycardia, and, in past, she has had extrasystoles.
Stress symptoms. She prefers savoury food to sweet food. In past she
liked very much the meat broth. Usually she does not look for milk or dairy.
Her hair is fat. She has intrusive thinking, perhaps more polarized than
fluctuating.
No computing of objects, for no reason,
occurs. She doesn't use any drug. No bad dreams, and habitually she does not
remember her dreams, doesn't have nighttime muscular cramps nor drooling during
the sleep. She does not awake as tired. Currently she has breakfast by forcing
a little, differently to what happened in past.
Others: The menstrual cycle, still running, it is short since several years. The
heat disturbs her. She doesn't have disbandment feelings, but she has
habitually low blood tension with a tendency to the collapse. No mediastinal
oppression, nor lump in the throat and nor stomachache occur. Rarely, she
suffers from colic and diarrhoea, and from oversweating. No motor slowing came
out. Currently she doesn't suffer from any headache. When she is born, delivery
risk factors or troubles were denied. Her family inclines to the anxiety.
Sudden asthenias did not pop up.
Test therapy (daily doses, by the oral via):
Glutamine 125mg; pyridoxine 75mg; carbamazepine 100mg: amitriptyline +
perphenazine 10mg + 2mg; oxazepam 7.5mg.
Half February 2005, the first checkup after
28 days of therapy. She did not begin at once the therapy, because having asked
advice from the physicians of her working place, they said to her that the
prescription was useless and surely ineffective because the low doses of drugs.
In spite of that she wanted to try the treatment, so beginning it with two
weeks of delay.
She is doing a little better. The cacosmia
reduced as the dysgeusia too. Her life improved.
Although less depressed, she referred of no
variations of her mood [???].
The exhausting gases of the cars are less
badly perceived and the same for the cigarette smoke. Her food choice did not
change. She feels less the head blocked by intrusive thinking. Now, she does
not awake so early, does not remember more the dreams, has in the same way
breakfast. She reports that till ten in the morning she is slowed. The menstrual
cycle did not change. In the last week she had little regression, as numbness
feeling. Not colic and diarrheas occurred. The tastes of the coffee and of the
chocolate are less anomalous.
No therapeutic variations.
Last third days of May 2005, the second
checkup, after four months of drug therapy. She still improved. The cacosmia
and the dysgeusia diminished, and she thinks that they reduced as 40%. As for
tastes, while before the therapy there was disgust, now there is a strange
taste but not disgusting as first. The fruit and vegetable consumption is still
low. The same is working for odours. As for fishes, there was an anosmia, but
now a distant odour or sometimes an excessive one (hyperosmia). She has less
intrusive thinking. She doesn't know if her hair is less fat. Now she remembers
the dreams. Besides, she says that in the morning she feels more confused than
she was before starting the therapy. Her menstrual cycle is unchanged. Colic
and diarrheas are always rare, as in past. Surely she is less depressed.
Therapy variation (daily doses, by the oral
via): Oxazepam stopped. I prescribed: Glutamine 250mg, carbamazepine 200mg,
bromazepam 0.6mg.
Second ten days of November 2005. In fact
there was a further improvement, but she thinks that perhaps it would have
occurred so even without any drug. The cacosmia and the dysgeusia are missing
(she believes to have improved at 50%) but the anosmia is now evident. She
feels however a smell of rotten fish, which not relates specifically with the
fish, but it is as general about olfactory scents from organic matters, even
referable to the human body. As for the taste, now she is eating anything,
without unpleasant feelings, but it not seems her to distinguish the various
flavours as one by one.
No therapeutic variation.
Discussion.
From the causal point of view, this trouble
of the taste and of the sense of smell, could reenter in the range of
idiopathic forms, but some elements keep us perplexed. Surely the patient was
in a stressful condition. Surely she has always had a certain sensibility to
the odours, increasing in emotional situations (as by stress produced and
producing).
The coming out of the smell and the taste
impairment, together a BPPV episode that had rehabilitative vestibular therapy,
does us to think. In the two cases I reported (Cocchi, 2003a; Cocchi 2003b) the
relationship between BPPV and stress seems a narrow one. I am writing so even
for a personal confirming experience. If the condition of probable glutamergic
excess acting first on target-organs of smell and balance, the vestibular
rehabilitative therapy may have raised a local threshold for it. Since the
general situation did not change, the glutamergic excess could have implied
smell and taste.
For this, the concomitant BPPV, may be meaningful.
For what remains, there are not significant variations in comparison with the
seven cases I reported elsewhere. despite some individual differences I saw in
this person, as the reduced putting into action of compensation mechanisms
(Cocchi 2002; Cocchi 2003c; Cocchi 2004a; Cocchi 2004b; Cocchi 2004c; Cocchi
2004d; Cocchi 2004e).
References.
Cocchi R. An anosmia-hyperosmia case with
hypogeusia, from probable stress, Improved following an antistress drug
therapy. 2002 <www.stress-cocchi.net/Other1.htm>..
Cocchi R. Benign paroxysmal positional
vertigo and stress: A case history of a patient, treated only with antistress
drugs.) Updated March 2004. 2003a <www.stress-cocchi.net/Other5.htm>..
Cocchi R. Benign Positional Paroxysmal
Vertigo, tinnitus, and hypacusia in a 48-years woman, treated with antistress
drugs. 2003b <www.stress-cocchi.net/Other6.htm>..
Cocchi R. A second case with
hyperosmia-anosmia with ageusia (a taste trouble), improved following an
antistress drug therapy. (Updated March 2004). 2003c
<www.stress-cocchi.net/Other8.htm>..
Cocchi R. A third case of anosmia-hyperosmia
with ageusia, following stress and possible viral infection, improved with an
antistress drug therapy. (Updated June 2005) 2004a
<www.stress-cocchi.net/Other7.htm>.
Cocchi R. A fourth case of anosmia, with
cacosmia and ageusia, treated with antistress and antidepressant drug therapy.
2004b <www.stress-cocchi.net/Other10.htm>.
Cocchi R. Hyperosmia in a woman with
atypical depression. His disappearance with the improvement of the depression.
(Updated and ended on January 2005). 2004c
<www.stress-cocchi.net/Other13.htm>.
Cocchi R. Hyperosmia, and headache's fits
from heavy, olfactory stimuli in a 35-years-old man of 35 years. An approach
with antiepilectic and antistress drugs. 2004d
<www.stress-cocchi.net/Other14.htm>.
Cocchi R. A case of melancholic depression
with hyposmia, ageusia, cacosmia and tinnitus. Its evolution with antistress
and antidepressant drug therapy. 2004e
<www.stress-cocchi.net/Depression5.htm>.
Gil-Carcedo E; Vallejo LA; Ortega P.
Proposed classification scheme for quantitative olfactory function alterations.
Otolaryngol Head Neck Surg 1999, 121: 820-825.
Posted on Internet on 20 July 2005. Copyright by Renato Cocchi, 2005.
Author's address: dr. Renato COCCHI, via Rabbeno, 3
42100 Reggio Emilia
email: renatococchi@libero.it
Drug modulation of stress answers