A young woman who would repeatedly experience the smell of burning incense (when in reality none burnt)
1. It was nearing the end of a busy OPD, when 27-year-old Radha was brought for consultation, accompanied by her husband and mother-in-law. They all looked anxious.
#MedTwitter
1. It was nearing the end of a busy OPD, when 27-year-old Radha was brought for consultation, accompanied by her husband and mother-in-law. They all looked anxious.
#MedTwitter
2. Radha married Raj a year ago. All went well until three months after marriage and the family was very happy.
One day at 11 PM, Radha started complaining that someone is burning incense at home, when all were actually sleeping. They considered it a dream & asked her to sleep.
One day at 11 PM, Radha started complaining that someone is burning incense at home, when all were actually sleeping. They considered it a dream & asked her to sleep.
3. These episodes increased in frequency and occurred 3-4 times every week. She would complain of burning incense smell at different times of day or night, and these symptoms would last only a few minutes.
Her family thought it's a God's message to her to pray with more devotion
Her family thought it's a God's message to her to pray with more devotion
4. Her MIL asked her to fast on 2 days every week and offer prayers to God to bless her with good health. Symptoms persisted despite the prayers. They consulted the village faith healer, on whose instructions, a yagya (special worship) was performed, which too yielded no result.
5. Radha continued to have recurring experience of burning incense 2-3 times per day. On a few occasions, she would appear to be in a "trance".
By now the family was fed up and they thought she has gone mad. Radha was taken to a #psychiatrist, who ruled out a #psychopathology.
By now the family was fed up and they thought she has gone mad. Radha was taken to a #psychiatrist, who ruled out a #psychopathology.
6. On psychiatrist's advice, she was brought for my opinion. I carefully analyzed her symptoms. Symptoms were always the same- #Smell of burning incense that lasted for a few minutes- typical of #olfactory #hallucinations. The state of trance was actually altered consciousness.
7. The diagnosis was clear in my mind. I asked her to get #MRI brain and #EEG tests.
They returned the next day with reports. MRI showed a #tumor in right medial temporal lobe involving amygdala. EEG showed epileptiform discharges arising from right temporal region.
They returned the next day with reports. MRI showed a #tumor in right medial temporal lobe involving amygdala. EEG showed epileptiform discharges arising from right temporal region.
8. Final diagnosis was- olfactory seizures due to right medial temporal lobe tumor. She was referred for surgery.
Radha made an excellent recovery and had no further episodes of "smelling burning incense" or going into "trance state" after surgery, during 3 months of follow up.
Radha made an excellent recovery and had no further episodes of "smelling burning incense" or going into "trance state" after surgery, during 3 months of follow up.
9.Take home message
*Abnormal smell sensations lasting for brief periods could be olfactory seizures arising from temporal lobe of brain.
*Brain scan and EEG would help in confirming the diagnosis.
*Treatment (medical or surgical, depending on cause) results in excellent outcome.
*Abnormal smell sensations lasting for brief periods could be olfactory seizures arising from temporal lobe of brain.
*Brain scan and EEG would help in confirming the diagnosis.
*Treatment (medical or surgical, depending on cause) results in excellent outcome.
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