A THIRD CASE OF
ANOSMIA-HYPEROSMIA WITH AGEUSIA, FOLLOWING STRESS AND POSSIBLE VIRAL INFECTION,
IMPROVED WITH AN ANTISTRESS DRUG THERAPY. (Uptdated November 2004)
Renato COCCHI, a neurologist and a medical
psychologist.
(Other ten articles on this topic)
Summary.
This article deals with the report of a
third case of anosmia-hyperosmia and cacosmia (smell troubles) with serious ageusia-disgeusia
(a taste trouble) in a patient of 45 years. These troubles arose during a
period of great stress and following a flu-like episode. A low dosing
antistress-antidepressant drug therapy, by acting on the GABA, on the
serotonin, on the dopamine and on the glutamic acid. The recuperation of the
taste and of the sense of smell, began after a month and half drug therapy and found in progress at the fourth checkup done after twelve months
therapy.
Key words: anosmia, hyperosmia, dysosmia,
ageusia, dysgeusia, stress, viral infection, depression, GABA, glutamate,
serotonin, dopamine.
Drug modulation of stress reactions
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A third case of anosmia-hyperosmia with partial
ageusia, in a professional of 45 years, came to my attention. The troubles of
the smell and the taste occurred after a long stressful time and a flu-like
syndrome and improved following an antistress drug therapy. Since its
singularity and its unusual characteristics, its history meticulously written
by the patient and brought to me in occasion of the visits, I wanted to give
here its report at a stretch, as up-to-dated at the second checkup during the
drug therapy.
A short review of the literature.
I rewrite here some interesting elements I
noted into the preceding articles (Cocchi, 2002; Cocchi 2003 ) as related to
past results, and to the present case.
The medical opinions based on the
experience, referred to the disorders of the senses of smell and of the taste,
are continuously growing since last years. We deal with a symptom that many
causal factors can elicit.
For anosmia it has to refer to every kind of
quantitative alteration of the sense of smell. This symptom may be induced from
more causal factors.
Dysfunctions of the chemical sense are often
secondary to one of fewer causes: Illnesses of the nose or of the paranasal
sinuses, viral infections, exposure to toxic chemical matters, cranial traumas,
conditions related to surgery, or idiopathic ones.
Outside the two cases described by myself(
Cocchi, 2002; Cocchi 2003), referred as without known cause (or idiopathic),
there were no suggestions between anosmia and stress.
The case hystory.
Man, of 45 years at first consultation. He
never abserved to have a particular hypersensitivity to the odors. What follows
is part of a report written by himself, except some integration of mine between
square brackets.
"My problems between 15-20 of July 20
2003 and I referred them to symptoms of anosmia/hypposmia [loss or reduced of
the smell] [with ageusia] or hypogeusia] and with probable cacosmia [and
dysgeusia]. Now, 19 November 2003 I find meself in a state where the level of
odors and of tastes could be definited like that:
- absolute loss of many odors and flavors;
- reduced perception of some odors and
flavors;
- transformation of most part of the odors
and flavors of the food usually eaten, in more or less unbearable smell and
scent.
Levels of perception vary from day to day,
however I do not perceive the flavors, as intended as the characteristic labels
that drive to appreciate the food and the relative perfumes. The
"therapies" I have got till now were prescribed by my general
practicioner (vitamins with the antioxidant aim, and the therapy for mygastritis)
and one cortisone injection prescribed by an otolaryngologist). What follows is
my illness course in details.
End June 2003: Psychophysical stress stored
for years, I was suffering from the exceptional summer heat, which worsened my
stressful condition. I caught a flu-like state with cold, badly of greed, and
fever treated with paracetamol, oxymetazoline hydrochloride spray,
dichlorobenzilic alcohol + amilmetacresol, an analgesic atomizer for the
throat.
Side notes: From three years and half I was
having lingual aphthae that no physician could explain in a reasonable way.
Could the stress cause even them?
20 July about: I started to feel not mostly
odours and flavours. My feeling was that the greatest part of the flavours had
been covered by the "chemical" odour of the exomeprazole tablet,
which I memorized at the beginning of the treatment following frequent gaseous
reflux.
In August 2003 I spent three weeks' holiday
by the sea + one week by a mountain lake. The closed nose made me difficult to
sleep.
The sea not had any curative effects, and
persisted the loss of the tastes and of the odours.
Therapies: exomeprazole; retinol +
tocopherol alpha acetate; Magnesium hydroxide + magnesium algeldrate (stopped
on 22 August). At the month end I stopped the exomeprazole, because I realized
that it has probably contributed - or it was the only cause? - of the onset of
the "chemical" taste that lasted for long. Among the side effects of
this drugs, there is the alteration of the taste.
In September 2003 I still have my nose
closed at night and, till the 10-12 September, I had also my left ear half shut
and with high frequency persistent tinnitus. The senses of smell and of taste
were absent. This last one came back attenuated only for some foods. For other
ones it transformed the smell into a chemical odour with different tones, some
of them unbearable.
Therapy: I took silimarine to help my liver
and to balance again the gastric motility, and even Triamcinolone acetonide
40mg/ml injection in muscles, to improve odours and flavours. I rested in
observation for twenty days.
My asthenia and tiredness persisted.
After the injection of Triamcinolone
acetonide it appeared a new odour, pleasant in comparison with the others, but
I cannot recognize from where it originates, whether the soap, the wood or
chemical products.
20 September about, Vit.C 1gr and omega3.1,
two capsules were added every day.
In October 2003, the absence of flavours and
odours in general rests. There is distorted and unbearable perception of
several flavours and odours, but I rediscovered some of them.
7 October: The brain NMR did a negative
result.
I succeeded to eat foods that first I could
neither smell. Anything is much inconstant and varies day by day. Several
unpleasant and/or unbearable smells persist. My mouth maintains a chemist
taste, mainly at night and in the mornings.
In November 2003, I feel me physically
better, since about 10-15 days. To about 12-13 days since the second cortisone
injection, some odours and flavours come out, but always alterated, some of
them bearable, other ones less. The less bearable tastes, perceived when I eat
a wrong food, appear following gaseous reflux during digestion and bother me a
lot, because they are lasting even the whole day.
The tiredness returned, as related to a more
intense working activity.
Therapy: On 1 October I repeated the
muscular injection of Triamcinolone acetonide, with twenty days of observation.
Assumption of C vitamin and of omega 3.1, is
going on.
Aphthae on the tongue, as above described,
did not disappear.
As for the tastes, from the long list
presented to me, I report only which the patient annotated in November.
"The odours and the favours not
perceived are innumerable.
I normally perceive: Sluga marketed croissant;
Pudding with the chocolate and milk; The odour of a bar of soap, which in last
September was very light.
I do not perceive: Some cheeses.
Perceived in various percentages, with
partial distortions, but bearable and with disappearance of some "chemical
aftertastes": salad 60%; white grapes 40%; carrots 40%; cuttlefishes in
white 20%; boiled rice 20%; potatos 20%; banana 20%; ice cream with lemon or
coconut 40%; bran biscuits 40%; raspberries 80%; meat (beefsteak and breast of
breaded chicken) 20%; green vegetables; apples, with a few pleasant aftertaste.
Attenuated odours perceived, not
specifically identifiable: Some types of soap and some types of perfume.
Tastes and odours modified or alterated (not
identifiable), with medium or high chemical few bearable odours: Fish, stewed
meat or fish; white meat; black grapes; some types of deodorants; cereals;
apples; beans; camomile; barley coffee; blackberries.
Tastes modified or alterated (not
identifiable),
Modified or alterated not recognizable
tastes, with chemical, burned, detergent-like strong unbearable smells: Wine;
coffee; licorice; mint candies; exhaust-pipe gas of cars; meat gravies, stewed
vegetables; tuna."
This list is extensive and illuminating,
beyond debatable so exact rates, probably due to the professional habit of the
patient.
On 26 November 2003, he had first
examination. There are no doubts about he is suffering from anosmia-hyperosmia
and cacosmia (smell loss or alteration) coupled with ageusia and dysgeusia
(taste loss or alteration). Currently he takes a regimen of C vitamin and omega
3.1.
Brain NMR had the report of "results
into normal limits".
Other laboratory examinations: first hour
blood corpuscles sedimentation 12 mm (normal superior limit: 10 mm ),
cholesterol 321 ( ideal: till 200 Mg/dl); Electrophoresis of the serum
proteins: A monoclonal component in the gamma zone, of 0.40 G/DL.
He is a sensitive man, doesn't do particular
physical activity, if not some early-morning gymnastics for cervical diskal
hernia. His mother had the so-called "Asiatic" flu in pregnancy. Born
to term, with birthweigh 2800g, he had meningitis when he was four.
Stress symptoms: He suffers from the heat,
has bad dreams, and at night he screams, has drooling, mainly about mornings,
but no nighttime cramps.
Often he wakes up early mornings and does
not fall asleep easily. In mornings hours he is tired, and he does not like to
have breakfast in early time. He did not taste sweet things, but now he can eat
some of them. He refuses meat broth.
Dizziness feelings but rare fainting
feelings occur. There is intrusive thinking with concentration problems.
Usually he does not bear both noise and people's confusion. Some dyslalias
happen every day. He is doing better in the mornings. After lunch he need to
rest and sleep. Emotional oversweating under the armpits occurs. He has the
habit to wash often his hands. No feelings of mediastinic oppression nor lump
in the throat were reported. Frequently he suffers from colic pain and
diarrhoea, but not in his sexual activity.
His hair is normal, but he inclined to have
his dental arches strongly shut in day time.
Problems linked to half-brain dominance
instability: To the test "Which is the opposite of the colour Red?",
he answers: "Green". For his wife he has The Contrary Mary feature.
He has bad feelings, that he feels as extraneous, towards persons who is fond
of each other. This symptom is disturbing him since three years, and he tries
to fight it with the religious assistance.
Trial therapy (daily doses, by the oral
via): Glutamine 125mg; pyridoxine 75mg; carbamazepine 100mg; amitriptyline +
perphenazine 10+2mg; oxazepam 15mg.
14 January 2004: The first checkup, after
about one month and half since the beginning of the drug therapy.
He is doing better. The taste has a faster
recover, and he thinks to have it recovered to 40-50%. For the sense of smell
instead he is not going beyond 20%. Till now, he bears still badly the odour of
the tinned tuna, however less than in past.
Problems linked to half-brain dominance
instability: For his wife he is The Contrary Mary as first: However, there is a
reduced emergency of bad thoughts against his family.
Stress symptoms: Sometimes he has anguish
moments. His sleep improved, but he has still some nighttime awakening. Perhaps
he screams less at night, fewer bad dreams, unchanged nighttime drooling. Less
intrusive thinking, but he is still lacking concentration even on job.
Now he is eating more sweet things. Not more
differences between mornings and afternoon persist. Less axillary oversweating,
less need of washing his hands, less colic and diarrheas occurred. He is always
affected by dyslalia, and dental shut did not change, as is intolerance to
noise and people's confusion.
He does half an hour of early-morning gymnastics
for his cervical hernia. His wife confirms the improvement, even seen by some
friends.
General personal evaluation:
"From the beginning of the drug
treatment I noted rather enough satisfactory improvements: Some foods, which
first I could neither smell, now I succeed even to eat them
They need still to be arranged:
* meats and fish, even if the repellent
chemical odours of these are little attenuated;
* odours of the foods, in general;
* some odours not still perceived;
* urine and faeces' odours fully different
from the normal.
I must report to Dr Cocchi:
- I have observed that the regimen makes me
rather sleepy even during the day; - to take back me, in the afternoon I need
to sleep at least one hour;
- During the night I wake up always for half
an hour - one hour now and I feel me a little tight while I am falling asleep
again.
Sometimes, I observed that rarely my nerves
[?; better the muscles] become contracted;
- While I speak, often (even before the
treatment, but now more often ) I realize that I forget some technical terms
and I don't succeed to finish my speech;
- As even first, I am not easy to do also
elementary calculations by heart (Is it idleness?);
- Often I feel me anxious and depressed;
- Aphthae on the tongue remain. I observed
that after a rest week (at Christmas ) they were attenuated, but is enough a
little stress to do them reappear;
- Since a long time my job seems me heavy (I
did always gladly all that pertains to it). The incoming problems seem
insurmountable to me."
Therapy variation: Oxazepam stopped. I
prescribed (daily doses, by the oral via): Carbamazepine 200mg; bromazepam
0.6mg; glutamine 250mg; alpha-tocopherol 100mg.
24 March 2004, the second checkup. He had difficulty
to bear the therapy variation out, for which he has shown irritability for two
weeks. Now he doesn't go badly, and his wife confirmed it, being present to the
visit.
The sense of taste: What pointed out as
"bad tastes" (coffee, tuna, beef or chicken meat) became attenuated.
Usually he eats bananas and apples, even if as the last ones he feels a little
bitter, and extraneous taste. Still some difficulty rests for oranges and
strawberries tastes, of which he feels primarily the perception of the sweet.
He thinks he has recovered 60% of the sense of the taste.
Sense of smell: The unpleasant smell of the
gas of the cars' exhaustive pipe is much attenuated, but lately he had little
regression on it. He doesn't perceive still the odours usually called unpleasant
(excrements, manure, etc.). He perceives better odours that are "a little
sweetish" and he smells unpleasantly the sweat odours of the persons. Now
he perceives again the perfume differences among different soaps, even if this
perception does not reach the best. Asked about it, he thinks he recovered
30-40% of the sense of smell.
This is his personal report he sent me by
email on 21 February 2004.
"I did not observe very evident and
disruptive changes since the last checkup (14 January 04), if not a general
attenuation in disturbing odours ( It is not a few). Such a phenomenon runs
quite slowly, so it happens that I do not realize either of the changes.
I perceive however that this change is in
progress and my wife mainly observed it, who patiently cooks and prepare the
foods. She pointed up that, as for both odours and flavours, I succeed to eat
things that about one month ago I could neither to sniff (`risotto' with cooked
spinach in the canonical way: with wine and onion; gilthead or sole, with
tomatoes), even if with real flavours and not always the same ones.
Till now I do not taste meat and fish,
even if the terrible related odours and flavours here even attenuated."
This is the following updating that I got on
24 March.
"29 February: Lunch: English style
Roast beef: It was enough good.
On March: I succeed to eat the `risotto',
cooked in the canonical way, not more only if it has mushrooms, but even with
other vegetables (spinach, pumpkin, marrows).
1 March: I drank nescafe'(TM): Not so
bad, even if the taste has "no thickness."
2 March: I ate stewed cuttlefishes and
peas: Enough good; I can eat the kiwi (not perfect, but good);
- The homemade pizza is not bad, even if
it has its flavours hidden. Where it is a few singed, I bear it less, so as for
the cooked ham. Usually
I succeed to eat it; However, its taste
is not pertaining to the pizza.
- Coke: It has only sweetish taste, but
bearable.
7 March: I tasted the roast rabbit: not
badly. I could chew it, perceiving
even the aroma of the roast that
maintained still a rather bitter veiling: It is a great footstep forwards.
9 March: Dinner: I tasted fish-soup. I
finally perceived again the taste of the fish (at 60%).
10 March: Lunch: The beefsteak to the
irons (rather high thickness ) with great satisfaction (70% good).
13 March: I tasted the
"Pavesini" TM cookies: they taste like chemist burnt.
15 March: I ate again the beefsteak as I
did on 10 March: It was a little less good.
20 March, dinner: I had a fish-soup like
on 9 March: It was decidedly worse. The food changes its taste when into mouth
and unpleasant odours and flavours come back. I was really disappointed.
Besides it, I often perceive, mainly when
I am close to other people, a
Strange odour like "a terrible soup
of vegetables." It seems that it is the sweat odour, since that even my
own is like that although less intense."
Problems of the half-brain dominance
instability: For his wife he is a
little less The Contrary Mary. The emergency of bad thought against his family
members went much down. Now it is 80% less as compared with what I had at
beginning of the therapy. Sometimes he speaks a word for an other, without that
the replaced word is a remarkable one or takes part of a usual sequence (like a
prayer, for an example).
Stress symptoms: He had fewer anguish moments. His sleeping
improved, and awakenings are rare. Now he doesn't howl more at night, bad
dreams are rare, and the nighttime salivation disappeared. He has less the head
blocked by thoughts (the intrusive thought) and in his job he succeeds to
gather of more.
He is eating sweet things as I did at the
preceding checkup. There are no differences between morning and afternoon. His
axillary oversweating did not change, but there is less need to wash his hands,
and colic and diarrheas disappeared. He is always affected by dyslalia. The
dental shut diminished. He is always equally intolerant to noise and confusion.
The mouth aphthae did not go down. During the day he feels slightly stunned,
Therapeutic variation (daily dosing, by the
oral via): Glutamine 125mg; carbamazepine 300mg, bromazepam 0.9mg.
30 June 2004, the third checkup. He thinks
that he recovered 65% the sense of the taste and 50% the sense of the smell
This evaluated seven months since the beginning of the current drug therapy.
Odour and taste: The unpleasant taste impact (dysgeusia) attenuated
in the most part, while less the olfactory. There is increased taste constancy.
The cacosmia for the tuna did not change. If
he sniffs it, the first approach is terrible, but when he continues to sniff it
the odour becomes more tolerable. The metallic and chemical heterosmias are now
much reduced. The sweat heterosmia of the persons, identified as minestrone
odour, is always the same. Faeces and urine, even his own, have still not their
smells, but with normal unpleasantness.
The odour of the coffee improved, and
sometimes, he succeeds to drinks it outdoor. It happens that the odour of the
coffee resembles to that of the hydrocarbons of the exhausted gas that he
smells in the road. He doesn't feel still the odour of the methane gas and of
some smokes.
The pink colour rose, which is fragrant, has
its perfume only to the first smelling. He felt in the air the odour of the
spring, and now feels that of the cut grass that is drying up.
Stress symptoms: He feels tired and he would like to sleep all the
day. When he sleeps much, the whitish spots on the tongue attenuate. His work
goes and comes, but altogether it not goes badly.
Problems of instability of the half-brain
dominance: Concentration is always a
problem. The emergency of bad feelings against beloved persons is very.gone
down
Prescribed therapy (daily doses, by the oral
via): Glutamine 125mg; SAMe 100mg; Pyridoxine 75mg; Levoarginine 830mg;
Carbamazepina 300 mg; Amitriptyline + perphenazine 10+2mg; Bromazepam 1mg.
This is the personal report he gave me on 30
June 2004.
On 20 April 2004:
Eatable foods, with good taste, but never
full taste: Bananas; potatoes; green
salad; rocket; Steer cost; polenta (maize pudding); bacon; pork underbelly;
cured raw beef; salami; carrots; artichokes; fennels; spaghetti with tomato
juice; chocolate; honey; lemon (it has much attenuated taste and a little
different); generally pasta and boiled rice without tomato juice; rice with
grow mouldy (first taste not good, but then it attenuates ), sweets in general.
Foods without flavours and/or odours: mozzarella cheese.
Tolerable foods (with some difficulty)
with changing flavours: `risotto'
with marrows and salmon; kid meat without wine and cube bullion; asparagus;
coffee (with a terrible initial odour, which then attenuates; It lacks its true
taste); apples; strawberries; pizza.
Not tolerable foods: Tuna; meatballs; fish; orange.
Bad odours, always distinct from the
reality, and poorly tolerable: Some
hydrocarbons; coffee; tuna; singed bread (they have a similar impact); sweat,
breathe (a taste of bad minestrone); faeces; urine.
Still now unscented: Methane gas; some flowers.
On the first June 2004:
Nonexistent odours: magnolia; several roses.
Odours and flavours existing and true
nearly real: Rose of pink colour;
pears.
Odours distinct from the reality: Melon; coffee; lemon.
Nonexistent tastes: Cherries.
17.11. 2004: The fourth checkup, after nearly a year of drug therapy: He
is doing decidedly better. In 70-80% of foods the taste is acceptable, even if
not always the same what was before the illness. The relief of the smell is now
at 60%.
łNow he succeeds to eat even the tuna, but
he cannot drink wine. The white wine inclines as too sweet, and the black has
too much an alcoholic taste. Now he bears the added wine to foods during
cooking.
Less anxiety and less useless worries run,
but he has still some depressive moments. The emergency of bad thoughts against
beloved persons reduced and he can better control them. As for his sexual life,
in August he had some difficulty to maintain his erection. The need of
urinating frequently did not change. He speaks about memory problems.
The odours are less confused, and nearly
even more unpleasant odours attenuated. Some of them are still cacosmic: the
onions and herbs lightly fried in oil, the exhausting gas (not all of them). He
does not smell some odours, but now he feels better the odour of the methane
gas distributed in the houses, The odour of the faeces is not still natural,
but not an unpleasant smell. That of the urine is an odour more
"bad".
No variation of the drug therapy.
This is the personal written report he gave
me during the examination.
July 2004:
Positive data: The gilthead bream and the
swordfish with tomato sauce: They are not really the best but they begin to
have a pleasant taste. I restarted to eat the watermelon: it has not a full
taste, because a little altered but pleasant.
The odour of the canned tune is not so
terrible, or better, the first impact is bad, and it lasts some seconds, then
it attenuates and I can perceive the tuna flavour. It is not perfect, and I
feel it at a distance, but it is much changed.
I could eat pork meatballs - which
previously I did not bear, both for the odour and for the taste -, with beans,
which first I did not succeed even to taste.
Now I can eat the bullock meat in
carpaccio style preparation. It is enough savoury, if not fair tasty.
I began to sense again the perfume that I
used before the event. While first It was unbearable, now I feel it attenuated
and I bear it.
Negative data: It continues a not
pleasant, confused, not identifiable odour for first courses with onions and
herbs lightly fried in oil. As for the chicken, its taste is always altered, of
bitter-chemical type, but less intense. The meat, in general, is always not
eatable because it has a bad taste.
The urine and of the faeces have altered
odours.
The exhausting gas of some cars is always
altered and negative.
August 2004.
Positive data: In August beginning, my
relationship with the canned tuna is improved. Now I can smell it, and I feel
its aroma, even at a distance. The terrible odour of the past is decidedly
attenuated.
Half-end August: I could taste a little
piece of canned tuna. It is not more so terrible, at least it seems.
I can sip even the coffee whose flavour
is not full but acceptable.
Usually, what I did previously get, it
seems improving qualitatively, and it seems that the gear is moving. It is like
that it began a slow process but it continues in positive sense. Odours and
tastes appear improving. The chemical type odours are attenuating.
Negative data: I could not eat the
Persian fish, fished by myself. For the family and our guests it was
exceptional.
I don't bear all the meat, excluding the
bullock, which is so, so.
Some food odours are not identifiable.
The exhausting gas of cars still bothers
me.
The odours of the urine and the faeces
are still altered.
September 2004.
Positive data: I was successful to eat a
supper based on fishes: All enough good (3 September).
The canned tuna: I am on the right road;
I can taste it. I drink coffee.
I could sniff the cooked ham, which was
unacceptable till August. It seems that the bad odour is attenuating.
Negative data: As for the meat, I have
tasted only one hamburger, and I did not find it much good.
Some food odours are not desirable.
Some exhausting gases of cars are still
terrible.
The smells of the urine odour and faeces are
still altered.
October 2004.
Positive data: I could eat the cooked
ham, (in crepes and in the pizza), the meat sauce, the canned tuna, the chicken
and pork sausages, the chestnuts, (the last year they were uneatable) whose
flavour is not full, escalopes with chicken breasts.
The coffee has a normal taste.
Negative data: The odour of the bread is
now altered. The pizza has not its aroma.
I cannot drink wine. The mandarin and
orange liqueur has the odour and flavours altered.
Exhausting gases of the cars are
unpleasant only sometimes.
Still altered the urine and faces odours,
but less.
November 2004:
Positive data: Now I can eat the pork
chops ( without taste, but the disgust has attenuated), the pork sausage, the meat
sauce, the braised of the steer, the calf cutlet, steer beefsteaks.
The soup of vegetable is enough good with
well identifiable flavours.
The acquired tastes are maintained to a
good level.
Negative data: The odour of the bread is
altered. I cannot drink wine. The mandarin and orange liqueur has altered
odours and flavours. The pizza does not own any aroma.
Still altered the urine and faeces'
odours, but less.
As for exhaustion gases of the cars, only
initially I feel them unpleasant, then this sensing attenuates.
There are still smells and flavours not
completely clear.
About the end of June 2005, the fifth
checkup after about 18 months of drug therapy. He is still improved, and thinks
of has always recovered about 80% of his sensibility, and now has eliminated
nearly all the cacosmia and the dysgeusia.
As for the taste sensory distortion, there
is remained something for some meats and for some fishes. Last Easter the
goatling was still unpleasant but now it is good. As for the fish, now it is in
hyperosmic phase, with odour of raw. If however he eats of the remained fish of
the day before, after it heated, this odour of raw is not more perceptible.
There are no problems for the frozen fish. Now he can eat anything, and he has
the disgust anymore, but not always there is the good taste. Tuna and coffee,
at the beginning they seem unpleasant, but this is a feeling that goes out at
once
As or smell: He perceives well all those
with an alcoholic component, but more in a confused way what it is exempt of
it. He starts to smell again the odour of the faeces, and even that of the
sewage purification plant worker, to which he passes near often when he is
going at work. Now, he feels lesser the odours of hydrocarbons.
Still difficulties to control the thinking
excess, he is feeling tires, and he has to sleep in the afternoon, otherwise he
does labour to sustain speaking, because he inclines to divert his mind. The
emergency of bad thought is much rare, and he succeeds to hold it under
control. He doesn't do more bad dreams, but he remembers some positive dream.
Since a week he has some nighttime
awakening, but he keeps sleeping again at once. Currently He has no nocturia,
but sometimes, frequent need to urinate during the day. Now he has become a
little impatient, and bears little everything that elicits him stress. In the
mountain he is more relaxed. He feels less anxiety, but he thinks he had little
panic attacks [???].
Current therapy (daily doses, by the oral
via): Carbamazepine 300mg; Amitriptyline + perphenazine 10mg + 2mg; Bromazepam
1.7mg; Creatine 3g; Glutamine 125mg; SAMe 100mg; Pyridoxine 75mg; Levoarginine
830mg.
Discussion.
The anosmia type here described is of easy
classification, according to the criteria of Gil-Carcedo, Gil-Carcedo, Vallejo and
Ortega, 1999. It perfectly adheres to the frame of the sense-neural anosmias,
central variety, which follows flu or flu-like.
Many features of this third case are
deserving our attention. The fact that it happened in a scrupulous
professional, for example, has allowed a description much accurately.
In the second place it has to say that too
not reentering into the range of the reversing anosmias with a specific causal
therapy (Reiss and Reiss, 2000), at the first checkup it occurred a good
recover of the taste and less of the sense of smell, after a month and half, of
an antistress drug therapy, and further progress after twelve months therapy.
The stress condition presence, since at
least three years, as the patient said, since many more years, according to the
anamnestic investigation, drives to an attempt of an etiological explanation.
This anosmia/ageusia could be linked to a
deficit of A GABAergic inhibition and glutamate excess.
Last, even this treatment not had any
psychotherapeutic support, in spite of being reserved as an essential element
of the therapeutic approach ( Koch-Gromus, and Schmeling-Kludas, 2000 ).
We can suggest here too some trouble in the
cells that elaborate the stimuli of the sense of smell (the complex of the
amygdala and the pre-pyriform area, according to Adams and Victor, 1989).
In this patient the list of the odours and
tastes altered or not more identified does not help us to think about specific
receptors. In a different way it happened in the first case, where mainly the
odours of the aliphatic hydrocarbons were involved (Cocchi, 2002 ).
By now it does not amaze more the
implication of the sense of the taste, even because it is not a novelty. The
association with the hyposmia forms an idiomatic syndrome described from Henkin
et al., 1971, or a flu-like result (Henkin and coll., 1975), as it happened
here.
Otherwise, we cannot say that the subjective
feeling corresponds to a true
Partial loss of the taste. This last sense
depends, to a large extent, from flying particles deriving from the foods and
from the drinks that reach the olfactory receptors by the nasal-pharyngeal
pathway.
The perception of the taste needs the
combination of the sense of smell and the sense of the taste (Adams and Victor,
1989). In the first case the mourned hypogeusia surely found one of its causes
in the anosmia or in the parosmia. We do not know if this was exhaustive,
having not the patient undergone specific tests for the sense of the taste.
Feelings of the taste hypersensitivity for
the bitter or for the acid has been described in some tumoral patients (Adams
and Victor, 1989).
In the present case to the loss of the test
a clear dysgeusia is adding, well described from the patient himself.
It is very curious the link with the
"flu with cold, badly of greed, and fever" occurred outside an
epidemic period. Near certainly it was a flu-like state, a definition that
leaves ample borders of spread medical subjectivity. It seems a stereotyped
diagnosis derived from the criterion of the similarity. Since it has the hinge
symptoms of the flu, it must have a link with the flu even if no epidemic flu
is in acts. Then it is a flu-like illness.
However flu symptoms are there, but it
cannot be said that they are flu or flu-like symptoms. They could be partly or
entirely a reaction of stress throughout a final common pathway.
What however it is important to say, is that
even in this patient the troubles of the senses of smell and of the taste seem
more followings of a dysfunctional state than of cells' loss. At least, we may
infer it from the partial recover already in short time. It is singular that
the taste recovers as fist, at least by now, even if with light regressive
fluctuations for some foods.
Conclusions.
This report of a third case of anosmia-hyperosmia
with serious ageusia-disgeusia in a patient of forty-five years, had a great
collaboration by the patient that described with trivial details and precision
his symptoms.
The trouble came out during a period of
heavy stress and following a flu-like episode. I faced it with an antistress
and antidepressant low dosing drug therapy, acting on the GABA, on the
serotonin, on the dopamine and on the glutamate. Recover of the taste and of
the sense of smell started after one month and half drug therapy and was found in progress at the fourth checkup after twelve-months
therapy.
(Other six articles on this topic)
References
Adams RG, Victor M.
Principles of Neurology. McGraw-Hill, New York, 1989.
Cocchi R. Un caso
di anosmia-iperosmia con ipoageusia, da probabile stress, migliorata a seguito
di una farmacoterapia antistress. Pubblicato su Internet nel giugno 2002
<www.stress-cocchi.net/Other1-it.htm>
Cocchi R. Un secondo
caso di iperosmia-anosmia con ipoageusia, migliorato a seguito di una
farmacoterapia antistress. Pubblicato su Internet nel dicembre 2003
<www.stress-cocchi.net/Other8-it.htm>
Gil-Carcedo LM;
Gil-Carcedo E; Vallejo LA; Ortega P. Proposed classification scheme for quantitative
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Powell RD. Hypogeusia, dysgeusia, hyposmia, and dysosmia following
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Posted on Internet March 2004. Copyright
by R. Cocchi, 2004.
Author's address: Dr Renato
COCCHI, via Rabbeno, 3
42100 Reggio Emilia
renatococchi@libero.it
Drug modulation of stress reactions
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