ABSTRACT
Objective: To assess olfactory function in individuals with classical (infratentorial) superficial siderosis (iSS) Background: iSS is a rare but potentially disabling and progressive neurological disorder that commonly involves auditory and vestibular neural pathways. Olfactory nerve function may also be affected but dedicated studies assessing this in iSS are lacking. Design/Methods: Ethics approval was granted. Eleven participants with a known diagnosis of iSS and no prior symptoms or history of COVID-19, were provided with the 40-item (British version) University of Pennsylvania Smell Identification Test (UPSIT) kits by post. The scores (40 as maximum best) were graded as normal, microsmia (mild/moderate/severe) and anosmia, as compared with age- and gender-matched norms;percentile values were obtained. Smoking status was determined;pack-years, years since smoking-cessation and disease duration (from presumed causative event) were calculated. Results: Ten participants completed the test. The mean (±standard deviation, SD) age was 52.5(±14.5) years;2 participants (20%) were females;6 participants (60%) never smoked;1 participant (10%) was a current smoker. The mean(±SD) UPSIT score was 25.5(±7.8), with no difference between males/females (t(10)=-1.528, p=0.165). The mean(±SD) disease duration (n=9) was 23.2(±11.4) years. The UPSIT scores were statistically significantly lower than age-/gender-matched norms (t(9)=4.016;p=0.003), and below the 30th centile for all participants (<10th percentile for 4 (40%);in 10-20th percentile for 5 (50%);in 20-30th percentile for 1 (10%)). Six participants (60%) had anosmia or moderate microsmia and 4 (40%) had mild microsmia. There was no correlation (as assessed by Kendall's tau-b, Tb ) (p>0.05) between the UPSIT scores and: age (Tb (10)=-.114);years since smoking-cessation (Tb (4)=.333), pack-years (Tb (4)=-.333), or disease duration (Tb (9)=.310). Conclusions: We report a novel quantitative assessment of the prevalence of olfactory dysfunction in iSS. Given its high prevalence, olfactory dysfunction may be another key feature of the iSS clinical syndrome that is currently under-investigated but should routinely be assessed. .
ABSTRACT
BACKGROUND AND PURPOSE: There are very few studies of the characteristics and causes of ICH in COVID-19, yet such data are essential to guide clinicians in clinical management, including challenging anticoagulation decisions. We aimed to describe the characteristics of spontaneous symptomatic intracerebral haemorrhage (ICH) associated with COVID-19. METHODS: We systematically searched PubMed, Embase and the Cochrane Central Database for data from patients with SARS-CoV-2 detected prior to or within 7 days after symptomatic ICH. We did a pooled analysis of individual patient data, then combined data from this pooled analysis with aggregate-level data. RESULTS: We included data from 139 patients (98 with individual data and 41 with aggregate-level data). In our pooled individual data analysis, the median age (IQR) was 60 (53-67) years and 64% (95% CI 54-73.7%) were male; 79% (95% CI 70.0-86.9%) had critically severe COVID-19. The pooled prevalence of lobar ICH was 67% (95% CI 56.3-76.0%), and of multifocal ICH was 36% (95% CI 26.4-47.0%). 71% (95% CI 61.0-80.4%) of patients were treated with anticoagulation (58% (95% CI 48-67.8%) therapeutic). The median NIHSS was 28 (IQR 15-28); mortality was 54% (95% CI 43.7-64.2%). Our combined analysis of individual and aggregate data showed similar findings. The pooled incidence of ICH across 12 cohort studies of inpatients with COVID-19 (n = 63,390) was 0.38% (95% CI 0.22-0.58%). CONCLUSIONS: Our data suggest that ICH associated with COVID-19 has different characteristics compared to ICH not associated with COVID-19, including frequent lobar location and multifocality, a high rate of anticoagulation, and high mortality. These observations suggest different underlying mechanisms of ICH in COVID-19 with potential implications for clinical treatment and trials.