ANOSMIA OR UNUSUAL ODOR
ANOSMIA OR UNUSUAL ODOR: Excerpt from Differential Diagnosis in Primary Care
Anatomy is an excellent method of recalling the possible causes of
anosmia and unusual odors.
-
Nasal passages. Focusing on the nasal passages, one can recall
upper respiratory infections, allergic rhinitis, chronic rhinitis of smoking
and/or overdose of decongestants,
polyps, sinusitis, and nasopharyngeal carcinomas.
-
Olfactory nervesmay be affected by fracture of the cribriform
plate or neoplasms.
-
The olfactory groove may be affected by trauma, neoplasm
(particularly a meningioma), or cerebral abscess.
-
Cerebrum. Considering the cerebrum will prompt the recall of
general paresis, encephalitis, basilar meningitis, multiple sclerosis, and
tumor of the frontal lobe. It should also help recall epilepsy, cerebral
aneurysms, and migraine. Unfortunately, this method will not help recall the
various drugs such as captopril and penicillamine that may cause anosmia. It
will also not prompt the recall of hysteria and various systemic diseases
(hypothyroidism, diabetes, renal failure, hepatic failure, and pernicious
anemia). By using the mnemonic VINDICATE these will not be missed.
Approach to the Diagnosis
If the disorder is the result of an acute infectious process, nothing
needs be done. If it is associated with trauma or there has been a gradual
onset, it is important to get a CT scan to rule out skull fracture or
neoplasm. It is essential to rule out drug and alcohol use at the outset by
a careful history and urine screen.
A good nasopharyngeal examination and nasopharyngoscopy must be done if
local disease is suspected. These may need to be complemented by x-rays or
CT scan of the sinuses. Systemic disease can be ruled out by a CBC,
chemistry panel, thyroid profile, serum B12 test, glucose tolerance test, and liver profile. If
epilepsy is suspected, a wake-and-sleep EEG needs to be done.
Other Useful Tests
-
Neurology consult
-
Otolaryngology consult
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MRI of the brain (brain tumor)
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Nasal smear for eosinophils (allergic rhinitis)
-
ANA titer (collagen disease)
-
Spinal tap (multiple sclerosis)
Pictures
Book Source Details
- Book Title: Differential Diagnosis in Primary Care
- Author(s): R. Douglas Collins MD, FACP
- Year of Publication: 2007
- Copyright Details: Differential Diagnosis in Primary Care, Copyright © 2007 Lippincott Williams & Wilkins.
More About Vaginal Dryness
More Medical Textbooks Online about Vaginal Dryness
Review other book chapters online related to Vaginal Dryness:
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- "The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter" (2000)
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Copyright notice for book excerpts: Copyright © 2008 Lippincott Williams & Wilkins. All rights reserved.
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