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Proceedings SNO “Percorsi clinici in Neuroscienze”

Case report I SESSIONE
“NEUROLOGIA AL TEMPO DEL COVID-19”

Unusual brain MRI finding in a patient
with COVID-induced persistent cacosmia

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G. FANELLA* , S. BERETTA* , F. PASINI* , C. BAIATA* ,
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A. DE VITO , G. BASSO* , C. FERRARESE* ✧
* School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
✧ Neurology Unit, Neuroscience Department, “S. Gerardo” Hospital ASST Monza, Italy
◆ Neuroradiology Unit, Neuroscience Department, “S. Gerardo” Hospital ASST Monza, Italy

INTRODUCTION was started on Carbamazepine 200 mg twice daily.
After 4 weeks of treatment, she did not report more
Olfactory dysfunction is emerging as a key symptom episodes of phantosmia, but no benefit on cacosmia
of COVID-19 along with other neurological compli- was reported. Due to side effects the treatment was
cations. Herein we describe a case of persistent ca- interrupted.
cosmia with an unusual finding on brain MRI. Furthermore, at 14 months from symptoms onset the
patient started to complain a subjective cognitive im-
pairment, therefore she underwent a neuropsycholog-
CASE REPORT ical assessment that highlighted low scores on work-
ing memory tasks and Rey complex figure test and
In March 2020, a 50-year-old woman with no rele- borderline score on verbal span. Mood evaluation
vant medical history developed fever, dry cough, dif- showed a medium-severe depressive disorder.
fuse muscle pain and sudden onset of anosmia and Brain MRI was performed with a 3 Tesla scanner be-
ageusia. She was diagnosed with Covid-19 by posi- fore treatment and 4 months after, respectively at 10
tive result on PCR analysis. Her clinical course was and 14 months after SARS-Cov2 infection. Bilateral
uncomplicated. Anosmia and ageusia started improv- hyperintensity of medial olfactory striae was evident
ing after two months. However, during the recovery on T2 3D FLAIR on both acquisition not associated
phase she started perceiving distorted and unpleasant with other significant imaging abnormalities (Figure
smells in response to stimuli (cacosmia) as well as 1). Currently the patient complains of persistent ca-
frequent sudden unpleasant smell sensations without cosmia and very low frequency phantosmia (1
any odorant stimuli (phantosmia). Because of the episode/month).
persistence of the symptoms, the patient referred to Collaterally, a diagnosis of psoriatic arthritis was
our neurological clinic. made and the patient was started on NSAID and im-
Neurological objective examination was normal. munosuppressive treatments.
EEG with olfactory stimulation showed a normal pat-
tern. Due to the persistence of phantosmia, the patient

Corrispondenza: Dr.ssa Gaia Fanella, Ospedale S. Gerardo, via G.B. Pergolesi 33, 20900 Monza (MB), e-mail: gaiafanella@
gmail.com
Percorsi clinici in Neuroscienze. Clinical Round SIN e SNO Lombardia, 21 gennaio 2022, Desio (Monza e Brianza)
Atti a cura di Paolo Ferroli, Alessandra Protti, Andrea Salmaggi, Ignazio Michele Santilli, Luca Valvassori
Copyright © 2022 by new Magazine edizioni s.r.l., Trento, Italia. www.newmagazine.it ISBN: 978-88-8041-135-2

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