Impairment of the chemical senses -smell, taste, and chemesthesis -has been pinpointed as one of the main clinical presentations of coronavirus disease 2019 . Chemosensory dysfunction can be quantitative, involving reduction or loss of perception (e.g., hyposmia, anosmia, hypogeusia), and qualitative, involving distortion of perception (parosmia and dysgeusia). Quantitative chemosensory dysfunction is reported more often among COVID-19 patients than qualitative dysfunction. The following report details four patients with a laboratory-assisted diagnosis of COVID-19 who experienced qualitative chemosensory dysfunction. A discussion of these symptoms in the broader context of upper respiratory tract infections is included, with an emphasis on olfactory dysfunction.
We present the case of a 65-year-old patient who suffered a wake-up brainstem stroke. The only symptom reported by the patient was double vision. Upon examination, she was found to have left internuclear ophthalmoplegia and ipsilateral downbeat nystagmus. Magnetic resonance angiography revealed a unilateral partial fetal posterior cerebral artery and unilateral posterior communicating artery hypoplasia. The patient was ineligible for intravenous thrombolysis: she evolved favorably with anti-platelet medication and was discharged after five days. We put forth a discussion on the clinical significance of these physical exams and magnetic resonance imaging findings.
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