Thread by @hyderabaddoctor

1. Mr Hari to his wife Mrs. Rani: "Have you lost all shame? Why are you changing dress in the living room, where our driver is waiting?"

Mr Hari had noted instances of mood swings in his 55-year old wife for the past six months but today's incident was shocking.
#MedTwitter twitter.com/i/web/status/1…

2. Mrs Rani was otherwise a pleasant woman, however, she had become irritable for the past few months. She would get agitated over small issues and go into a shell (for several hours) on many occasions. She would refuse to talk to her husband and even refuse food.

3. Mr Hari attributed these changes in her personality to post-menopausal symptoms and tried to ignore them, and hoped she would get back to her previous self soon.
He had noted inappropriate behavior in his wife on a few occasions, when she would crack jokes with strangers.

4. The only other issue that troubled Mrs Rani was her poor sense of smell. This had started three years back with the onset of covid pandemic. Even though she never had typical symptoms of covid (& tested negative for covid), her loss of smell was attributed to covid19 infection

5. Mrs Rani had gotten used to living with loss of smell (& partial loss of taste).
However, today she had crossed the limits of decency. When questioned by her husband, she could not give convincing answers regarding her inappropriate behavior (for changing dress in public).

6. Mrs Rani promised to take care in future.
All was apparently going well, when three weeks later, Mr Hari was woken up with a loud scream of his wife, who was sleeping beside him. He found her unconscious & she had passed urine in the bed. She was rushed to emergency dept (ED).

7. Mrs Rani had regained consciousness by the time she reached ED, however, she couldn't recollect what had happened to her, and why she was brought to the hospital.
CT scan of the brain was ordered.

8. CT scan showed a large tumor in the frontal region of brain near the olfactory nerve (responsible for smell function).
The extent of tumor was confirmed with MRI brain with contrast. Neurosurgery opinion was taken.

9. Based on clinical and radiological findings, a final diagnosis of olfactory groove meningioma (OGM)- a benign tumor was made.
After detailed counseling, she underwent complete resection (removal) of tumor. Neurosurgeons managed to preserve right-sided olfactory nerve.

10. Biopsy of the tumor confirmed the clinical diagnosis.
She was continued on anti-epileptic drugs to prevent further seizures.
On follow up at three months, Mrs Rani had partially regained sense of smell. Her mood symptoms & personality changes had also improved.

11. Take home message
*Loss of sense of smell (anosmia) is fairly common and often caused due to common cold. Covid infection is another common cause.
*Brain-related causes of anosmia include stroke, tumor, head injury or infections, are relatively less common.

11a.
*Brain scan is not recommended for all cases of anosmia. However, in patients with anosmia, who also have headache, personality or mood changes, vision impairment or convulsions, a brain MRI should be done.
*Early detection and surgical resection results in good outcome.