Anosmia after aneurysmal subarachnoid hemorrhage.
OBJECTIVE
Anosmia has an important impact on well-being but is often neglected by physicians. In patients with subarachnoid hemorrhage (SAH), anosmia has mainly been reported after surgery for aneurysms of the anterior communicating artery. We studied the prevalence, predisposing factors (aneurysm site and type of treatment), impact, and prognosis of anosmia in patients with SAH.


METHODS
Of the patients with SAH who resumed independent living, we included all patients treated by coiling between 1997 and 2003 and a sample of patients treated by clipping between 1985 and 2001. Patients underwent structured interviews regarding the presence and duration of anosmia. The impact of anosmia was scored using a visual analog scale ranging from 0 (no influence) to 100 (the worst thing that ever happened to them). Risk factors for anosmia were assessed by logistic regression analysis.


RESULTS
Overall, 89 of the 315 interviewed patients (28%; 95% confidence interval [CI], 23-34%) reported anosmia after SAH (mean follow-up period, 7.4 yr), including 10 (15%) of the 67 coiled patients and 79 (32%) of the 248 clipped patients. The median visual analog scale impact score was 53 (range, 0-100). In 20 of the 89 patients (23%; 95% CI, 15-33), the symptoms had improved over time. Risk factors for anosmia were treatment by clipping (odds ratio [OR], 2.7; 95% CI, 1.3-5.7) and anterior communicating artery aneurysms (OR, 2.0; 95% CI, 1.2-3.3).


CONCLUSIONS
Anosmia after SAH has a high prevalence, considerable impact, and poor prognosis. Its occurrence after coiling suggests not only damage to the olfactory nerve by clipping but also that the SAH itself plays a role in its pathogenesis.
Wermer
Marieke J H
MJ
Department of Neurology, Rudolf Magnus Institute of Neuroscience, University Medical Center Utrecht, Utrecht, The Netherlands. m.wermer@umcutrecht.nl
Donswijk
Maarten
M
Greebe
Paut
P
Verweij
Bon H
BH
Rinkel
Gabriël J E
GJ
D015897:Comorbidity; D004621:Embolization, Therapeutic / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D000857:Olfaction Disorders / Q000453:epidemiology*; D011183:Postoperative Complications / Q000453:epidemiology*; D015995:Prevalence; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D013345:Subarachnoid Hemorrhage / Q000453:epidemiology* / Q000628:therapy*; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000706:statistics & numerical data*