Proteomic Characterization of the Olfactory Molecular Imbalance in Dementia with Lewy Bodies.

Olfactory dysfunction is one of the prodromal symptoms in dementia with Lewy bodies (DLB). However, the molecular pathogenesis associated with decreased smell function remains largely undeciphered. We generated quantitative proteome maps to detect molecular alterations in olfactory bulbs (OB) derived from DLB subjects compared to neurologically intact controls. A total of 3214 olfactory proteins were quantified, and 99 proteins showed significant alterations in DLB cases. Protein interaction networks disrupted in DLB indicated an imbalance in translation and the synaptic vesicle cycle. These alterations were accompanied by alterations in AKT/MAPK/SEK1/p38 MAPK signaling pathways that showed a distinct expression profile across the OB-olfactory tract (OT) axis. Taken together, our data partially reflect the missing links in the biochemical understanding of olfactory dysfunction in DLB.

Remission of anosmia in a patient receiving chiropractic care: A case report.

OBJECTIVE: To chronicle the remission of anosmia in a 79-year-old female receiving chiropractic care using the Activator Methods Chiropractic Technique (AMCT) protocol. CLINICAL FEATURES: A 79-year-old white female with a 4-year history of medically diagnosed anosmia. Postural alterations, reduction in cervical ranges of motion (ROM), and absent cranial nerve I function were found in conjunction with vertebral subluxation throughout the spine and mild to severe degenerative changes throughout the spine present on radiographic studies. INTERVENTION & OUTCOMES: Chiropractic care using AMCT was provided for the assessment and correction of vertebral subluxations. The patient reported subjective improvement in olfaction, physical functioning and life enjoyment, and demonstrated objective improvement in posture, cervical ROM, cranial nerve I function. CONCLUSION: A course of chiropractic care, following the AMCT protocol, was associated with remission of anosmia.

Endoscopic endonasal versus transcranial approach to resection of olfactory groove meningiomas: a systematic review.

Despite the increasing utility of the endoscopic endonasal approach (EEA) for management of anterior skull base (ASB) pathologies, the optimal treatment strategy for olfactory groove meningiomas (OGM) remains unclear. This project sought to systematically compare outcomes of EEA management with conventional transcranial approach (TCA) for the treatment of OGMs. A systematic review was performed to identify studies that compared outcomes following EEA and TCA for OGMs. Data extracted from each study included gross total resection (GTR), incidence of cerebrospinal fluid (CSF) leaks, and post-operative complications including anosmia. The results of the search yielded 5 studies which met the criteria for inclusion and analysis. All studies compared TCA (n = 922) with EEA (n = 141) outcomes for OGMs. Overall, the rate of gross total resection (GTR) was lower among the endoscopic group (70.9%) relative to the transcranial group (91.5%). The rate of post-operative CSF leak was 6.3% vs. 25.5% for the transcranial and endoscopic groups, respectively. Post-operative anosmia was higher for patients undergoing EEA (95.9%) compared with patients in the transcranial group (37.4%). In this analysis, EEA was associated with a lower rate of GTR and higher incidences of CSF leaks and post-operative anosmia. However, with increasing surgeon familiarity of the endoscopic anatomy and technique for managing ASB pathologies, a nuanced approach may be used to minimize patient morbidity and widen the spectrum of skull base surgery.

El COVID-19 también Afecta el Sistema Nervioso por una de sus Compuertas: El Órgano Vascular de la Lámina Terminal y el Nervio Olfatorio. Alerta Neurológica, Prueba de Disosmia o Anosmia Puede Ayudar a Un Diagnóstico Rápido / COVID-19 also Affects the Nervous System by One of its Gates: The Vascular Organ of Lamina Terminalis and the Olfactory Nerve. Neurological Alert, Dysosmia or Anosmia Test Can Help to A Quick Diagnosis

Se presenta una breve revisión de órgano vascular de la lámina terminal (organum vasculosum laminae terminalis) y el nervio olfatorio, el primero un elemento neuroanatómico hipotalámico relacionado con la producción de hormona antidiurética y su asociación como una vía potencial de invasión del COVID-19 al sistema nervioso central, afectando la regulación fisiológica de liberación de hormonas relacionadas con la homeostásis del sodio. También se vincula el neurotropismo de este virus al asociarse con el nervio olfatorio, una evaginación del cerebro en la que se altera su funcionalidad por generación de disosmia entre otras características neurosemiológicas. Se plantea la necesidad de advertir a los profesionales de la salud en general y a los neurólogos en especial, sobre las potenciales alteraciones neurológicas relacionadas con esta pandemia antes y después del contagio de este virus e implementar una prueba olfatoria rápida con ácido acético, incluso antes de otras valoraciones como hipertérmia, tos y cefalalgia.

Olfactory impairment in frontotemporal dementia: A systematic review and meta-analysis / Alterações olfatórias em Demência Frontotemporal: Revisão sistemática e meta-análise

ABSTRACT. Frontotemporal dementia (FTD) presents clinically in three variants: one behavioral and two with progressive primary aphasia - non-fluent/agrammatic and semantic. Defined by the degenerative process and cerebral atrophy, olfactory dysfunction occurs in up to 96% of previous FTD case series. Objective: the present study aims to critically synthesize data about the relationship between FTD and olfactory impairment to analyze the usefulness of olfactory evaluation tests as a complementary element in early diagnosis. Methods: a database search was performed using the keywords "olfactory OR smell OR olfaction AND frontotemporal dementia". We included studies that evaluated olfactory function in patients diagnosed with frontotemporal dementia, all subtypes, compared with age-matched healthy controls. For comparative purposes, the effect size was calculated using Cohen's D. The studies selected were categorized according to dementia variant and olfactory test type. A meta-analysis was performed using forest plots - homogeneity was evaluated by statistical tests (i2 and Cochran Q). Results: ten articles met the inclusion criteria. Heterogeneity was classified as low for semantic dementia olfactory identification and behavioral variant olfactory discrimination groups (i2 = 0 and 3.4%, respectively) and as moderate for the behavioral variant olfactory identification group (i2 = 32.6%). Conclusion: patients with the frontotemporal dementia behavioral variant seem to present with alterations in odor identification, but with preserved discrimination. Scent identification also seems to be impaired in semantic dementia. Therefore, we conclude that olfactory evaluation in these patients is possibly impacted by cognitive alterations and not by sensory deficits. Application of olfactory tests may prove important in differentiating prodromal states from other types of dementia with more pronounced olfactory impairment.

RESUMO. A demência frontotemporal apresenta-se clinicamente em três variantes: uma comportamental e duas com afasia progressiva primária - não fluente/agramática e semântica. Definida pelo processo degenerativo e atrofia cerebral, apresenta uma prevalência de disfunção olfatória de até 96% em séries anteriores. Objetivo: o presente estudo objetiva sintetizar criticamente dados sobre a relação entre DFT e o comprometimento olfatório para analisar a utilidade dos testes de avaliação olfatória como elemento complementar no diagnóstico precoce. Métodos: uma pesquisa de banco de dados foi realizada usando as palavras-chave "olfactory OR smell OR olfaction AND frontotemporal dementia". Foram incluídos estudos que avaliaram a função olfatória em pacientes com diagnóstico de demência frontotemporal, todos os subtipos, em comparação com controles saudáveis ​​pareados por idade. Para fins de comparação, o tamanho do efeito foi calculado usando D de Cohen. Os estudos selecionados foram separados por variante de demência e tipo de teste olfativo. Uma meta-análise foi realizada utilizando gráficos floresta - sua homogeneidade foi avaliada por testes estatísticos (i2 e Cochran Q). Resultados: dez artigos preencheram os critérios de inclusão. A heterogeneidade foi classificada como baixa para os grupos de identificação olfatória em demência semântica e discriminação olfatória em variante comportamental (i2 = 0 e 3.4%, respectivamente) e moderada para identificação olfatória no grupo de variante comportamental (i2 = 32.6%). Conclusão: pacientes com variante comportamental de demência frontotemporal parecem apresentar alterações na identificação de odores, com discriminação preservada. A identificação de odores parece estar prejudicada, também, na demência semântica. Desta forma, concluímos que a avaliação olfatória nesses pacientes é possivelmente impactada por alterações cognitivas e não por déficits sensoriais propriamente. A aplicação de testes olfatórios pode ser importante na diferenciação de estados prodrômicos de outros tipos de demência com comprometimento olfatório mais pronunciado.

First recognized n-butanol concentration may be simple and useful index for assessing olfactory dysfunction in geriatric patients.

The KVSSII is widely used to evaluate olfactory function in the Korean population. We evaluated the usefulness of the first recognized n-butanol concentration, which is obtained at the beginning part of KVSS II, in predicting olfactory dysfunction. Three hundred seventy two subjects were enrolled in our study. The results of KVSS II and the demographic characteristics were statistically analyzed. The first recognized n-butanol concentration was positively correlated with the result of KVSS II. The mean value of first recognized n-butanol concentration was 5.59 ± 1.42 in normosmia, 4.10 ± 1.40 in hyposmia, and 0.84 ± 1.68 in the anosmia group. By ROC curve, cut-off value of 2.5 showed sensitivity of 85.9% and specificity of 90.6% for anosmia, and cut-off value of 4.5 showed sensitivity of 77.6% and specificity of 69.8% for hyposmia. Consequently, we suggest that it may be useful in assessing olfactory function, in geriatric patients who are not able to tolerate conventional KVSS II.

Prognostic value of olfactory nerve damage measured with thallium-based olfactory imaging in patients with idiopathic olfactory dysfunction.

Idiopathic olfactory disorder is resistant to treatment, and the recovery time is long. This study investigated the prognostic value of the migration of nasally administered thallium-201 to the olfactory bulb (thallium migration to the OB), a measure of olfactory nerve damage, in patients with idiopathic olfactory disorders. Twenty-four patients with idiopathic olfactory disorders were enrolled in the study (7 women and 17 men; aged 23-73 years). We retrospectively analyzed potential prognostic markers in subjects who underwent thallium-based olfactory imaging with the nasal administration of thallium-201 before conventional treatment with the Japanese herbal medicine tokishakuyakusan and compared those data with the prognosis. Log-rank tests were performed to assess the relationship between thallium migration to the OB (<4.6% [low] vs. ≥4.6% [high]; data dichotomized at the optimal cutoff value) and the duration until recovery of the odor recognition threshold determined by a standard olfactory function test (T&T olfactometry) after the treatment. Upon statistical analysis, we found that high thallium migration to the OB was significantly correlated with better prognosis in patients. Our results suggest that patients with intact olfactory nerve fibers could be selected using thallium-based imaging for the long-term follow-up of olfactory dysfunction.

Analyses and treatments of postoperative nasal complications after endonasal transsphenoidal resection of pituitary neoplasms.

In this study, we analyze and discuss the treatments of postoperative nasal complications after endonasal transsphenoidal resection of pituitary neoplasms (PNs). We performed 129 endonasal transsphenoidal resections of PNs and analyzed and treated cases with nasal complications. After endonasal transsphenoidal resection of PNs, there were 26 cases of postoperative nasal complications (20.1%), including nasal hemorrhage (4.8%), cerebrospinal fluid rhinorrhea (6.9%), sphenoid sinusitis (2.3%), atrophic rhinitis (1.6%), olfactory disorder (1.6%), perforation of nasal septum (0.8%), and nasal adhesion (2.3%). All patients clinically recovered after therapy, which included treatment of the cavity through nasal endoscopy, intranasal corticosteroids, and nasal irrigation. We propose that regular nasal endoscopic review, specific nasal medications, and regular nasal irrigation can effectively clear nasal mucosal hyperemia-induced edema and nasal/nasoantral secretions, as well as promote regeneration of nasal mucosa, prevent nasal adhesion, maintain the sinus cavity drainage, and accelerate the recovery of the physiological function of the paranasal sinus. Timely treatment of patients with nasal complications after endonasal transsphenoidal resections of PNs could greatly relieve the clinical symptoms. Nasal cleaning is very beneficial to patients after surgery recovery.

Isolated olfactory bulbs agenesis: an extremely rare entity / Agenesia aislada de los bulbos olfativos: una entidad extremadamente rara

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An enigmatic clinical entity: A new case of olfactory schwannoma.

Olfactory schwannomas, also described as subfrontal or olfactory groove schwannomas, are very rare tumors, whose pathogenesis is still largely debated. We report a case of olfactory schwannoma in a 39-year-old woman who presented with anosmia and headache. The clinical examination did not show lesions in the nose-frontal region and there was no history of neurofibromatosis. Head MRI and CT scan revealed a lobulated extra-axial mass localized in the right anterior cranial fossa that elevated the ipsilateral frontal pole. Bilateral frontal craniotomy demonstrated a tumor strictly attached to the right portion of the cribriform plate that surrounded the right olfactory tract, not clearly identifiable. The immunohistochemical analysis suggested the diagnosis of typical schwannoma. The patient was discharged without any neurological deficit and a four-month postoperative MRI scan of the brain showed no residual or recurrent tumor.

[Diagnosis of olfactory disorders]. / Diagnostik bei Riechstörungen.

Alongside a structured case history, the measurement of olfactory function and diagnosis of olfactory dysfunction is of great clinical importance. Validated and established methods have been developed to this aim. The "Sniffin' Sticks" test battery is an easy-to-use tool for assessing olfactory function. Recording of olfactory event-related potentials is a more objective approach, which is particularly important in medicolegal cases. Imaging techniques such as MRI and CT provide additional information in the diagnosis of olfactory disorders. The latter techniques enable the anatomical structures of the skull and brain with the areas relevant to olfactory function to be evaluated.

Olfactory schwannoma: a report of two cases and literature review.

Intracranial schwannoma is a kind of benign intracranial tumors, derived from neuron myelin sheath, growing slowly and curable. Olfactory schwannoma is an exceedingly rare kind of schwannoma, whose origin is still uncovered. Although several theories have been put up for pathogenesis of olfactory schwannoma, till now, none of these hypotheses has been widely accepted and acknowledged officially. Up to date, only 46 cases of olfactory schwannoma were reported across numerous institutes worldwide. Here we gathered two cases from Department of Neurosurgery in Beijing Tiantan Hospital across two years collection.

Olfactory colloid cyst: case report and review of extraventricular colloid cyst literature.

OBJECTIVE: A rare case of an extraventricular colloid cyst located in the olfactory groove extending downward into the ethmoid sinus is presented. This is the second reported case in the world literature. METHODS: A 56-year-old-woman presented with a lesion that was causing hyposmia and cerebrospinal fluid rhinorrhea. The lesion was an extraventricular colloid cyst displacing the left olfactory nerve downward and eroding into the left ethmoid sinus. RESULTS: The lesion was excised, and the anterior skull base was reconstructed successfully via a unilateral subfrontal approach. CONCLUSIONS: There were no complications, and the patient made a full recovery, with resolution of the cerebrospinal fluid rhinorrhea.

The olfactory system.

Any dysfunction in olfaction requires a radiological exploration comprising the nasal cavity, the anterior base of the skull, in particular the frontal and temporal lobes. MRI is the reference examination, due to the frontal plane and the T1, T2 volume maps. In the child, aplasia of the olfactory bulbs falls within a polymalformation (CHARGE) or endocrine (Kallman) context. In the adult, rhino sinus disease and meningiomas are the most common etiologies. Frontal or temporal impairment: tumoral or vascular and neurodegenerative disorders (Parkinson's disease) may accompany a loss of olfaction.