Departments of Neurology, Behavioral Neurology (Carlisle, Filley) and Headache (Birlea) sections, Psychiatry (Filley), and Cell and Developmental Biology (Restrepo), University of Colorado School of Medicine, Aurora; Marcus Institute for Brain Health, Aurora (Filley).
J Neuropsychiatry Clin Neurosci. 2023 Winter;35(1):92-97. doi: 10.1176/appi.neuropsych.21110265. Epub 2022 Aug 22.
Olfactory hallucinations, or phantosmias, can occur in many neurological, psychiatric, and medical conditions, but no widely used standardized approach exists to comprehensively assess qualitative olfactory dysfunction in the clinical setting. Additionally, medical professionals, patients, and their family members may not recognize phantosmia as a potentially neurological problem. Given the many possible etiologies for symptomatic phantosmia, it is important to recognize this unusual presentation and elicit a meaningful history to explore the potential underlying cause. We describe a 77-year-old gentleman with a two-year history of headaches accompanied by smelling a foul odor and discuss the differential diagnosis for new onset and persistent phantosmia. This unusual case ultimately manifested features consistent with Lewy body dementia, highlighting the varied clinical presentations that are possible with this neurodegenerative disorder. We discuss the possible pathophysiology of phantosmia in Lewy body disorders, including a proposed mechanism for olfactory hallucinations arising prior to the typical well-formed hallucinations in Lewy body dementia.
嗅觉幻觉，或幻嗅，可以发生在许多神经学、精神病学和医学病症中，但目前还没有广泛使用的标准化方法来全面评估临床环境中的定性嗅觉功能障碍。此外，医疗专业人员、患者及其家属可能没有将幻嗅识别为潜在的神经问题。鉴于症状性幻嗅有许多可能的病因，重要的是要认识到这种不寻常的表现，并进行有意义的病史采集，以探讨潜在的根本原因。我们描述了一位 77 岁的男性，他有两年的头痛病史，伴有闻到恶臭的气味，并讨论了新发和持续幻嗅的鉴别诊断。这个不寻常的病例最终表现出与路易体痴呆一致的特征，突出了这种神经退行性疾病可能具有的各种临床表现。我们讨论了路易体障碍中幻嗅的可能病理生理学，包括提出的一种机制，即嗅觉幻觉在路易体痴呆中典型的有形成分幻觉出现之前出现。
