Olfactory dysfunction after subarachnoid hemorrhage caused by ruptured aneurysms of the anterior communicating artery

Clinical article

Gemma Escartin Martin M.Sc.1,2, Carme Junqué Ph.D.5, Montserrat Juncadella Ph.D.1,2, Andreu Gabarrós M.D.3, Maria Angels de Miquel M.D.4, and Francisco Rubio M.D., Ph.D.2
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  • 1 Neuropsychology Unit,
  • | 2 Department of Neurology, and
  • | 3 Departments of Neurosurgery and
  • | 4 Neuroradiology, University Hospital of Bellvitge; and
  • | 5 Department of Psychiatry and Clinical Psychobiology, University of Barcelona and Institut d'investigacions Biomèdiques Agustí Pi i Sunyer, Barcelona, Spain
Page Range:
958–962
Volume/Issue:
Volume 111: Issue 5
DOI link:
https://doi.org/10.3171/2008.11.JNS08827
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Object

Olfactory dysfunction has an important impact on quality of life. In patients with subarachnoid hemorrhage (SAH), anosmia has mainly been reported after surgery for aneurysms of the anterior communicating artery (ACoA). The authors studied whether and how frequently patients with ACoA aneurysms present with smell identification deficits in 2 treatment groups (endovascular and surgical treatment).

Methods

A prospective study was conducted of patients with SAH caused by ruptured ACoAs and who had a Glasgow Outcome Scale score of 1 or 2, in comparison with a control group matched by age and sex. Olfactory function was assessed using the University of Pennsylvania Smell Identification Test (UPSIT).

Results

A total of 39 patients were enrolled. A marked olfactory impairment was observed in patients with ruptured ACoAs compared with the control group (p < 0.001). Seventeen patients with ruptured ACoAs (44%) compared with 1 patient in the control group (3%) showed a smell identification deficit according to performance on the UPSIT (p < 0.001). Both groups that underwent treatment presented with olfactory impairment. Ten (59%) of 17 patients who underwent aneurysmal clip placement versus 6 (28.5%) of 21 patients who underwent coil embolization scored below the 25th percentile on the UPSIT, and surgical patients also performed worse than endovascular patients (p = 0.048). The authors observed a worse performance on the olfactory test in patients subjected to endovascular coil embolization when cerebral vasospasm (p = 0.037) or frontal cerebral lesions (p = 0.009) were present. This difference was not observed in patients who underwent surgery.

Conclusions

Olfactory disorders after SAH caused by rupture of the ACoA are very frequent and were present in both treatment groups. Cerebral vasospasm and frontal lobe lesions are related to worse performance on an olfactory test in patients undergoing endovascular coil embolization.

Abbreviations used in this article:

ACoA = anterior communicating artery aneurysm; SAH = subarachnoid hemorrhage; UPSIT = University of Pennsylvania Smell Identification Test.

Volume 111: Issue 5 (Nov 2009)

in Journal of Neurosurgery
Cover Journal of Neurosurgery

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