From the Guidelines
The prognosis for a young man with minimal neurological symptoms, such as headache, epistaxis, and anosmia, who has MRI findings of hemorrhagic brain contusions, is generally favorable, with most patients recovering well over weeks to months, as supported by the most recent study from 2022 1. The MRI shows two main areas of concern: a focal hemorrhagic contusion in the left basifrontal lobe with surrounding edema, and a smaller lesion in the right anterior frontal lobe. These findings are consistent with traumatic brain injury, likely from a recent head trauma.
- The anosmia (loss of smell) may be related to injury to the olfactory nerves near the basifrontal area and could be temporary or permanent.
- Treatment usually involves rest, pain management, and close neurological monitoring.
- Complete recovery is possible, though some patients may experience persistent mild symptoms like headaches or subtle cognitive changes.
- Regular follow-up with a neurologist is important to monitor healing and address any emerging symptoms.
- The mastoid air cell finding is likely incidental and unrelated to the primary condition. According to the 2021 study, MRI is more sensitive than CT for subtle findings adjacent to the calvarium or skull base, such as small cortical contusions and subdural hematomas 1. However, the 2022 study provides more recent and comprehensive information on the prognosis of traumatic brain injury, highlighting the importance of early diagnosis and treatment 1. In this case, the patient's mild symptoms and MRI findings suggest a favorable prognosis, with a high likelihood of recovery over time.
From the Research
Prognosis of Anosmia
The prognosis of a young man with almost no neurological symptoms, just headache, few drops of blood from nose, and anosmia, depends on various factors, including the underlying cause of anosmia.
- Based on the MRI report, the patient has a focal area of altered signal intensity involving the left basifrontal lobe, likely a hemorrhagic brain contusion with surrounding edema, and a small suggestive/enhancing focus of altered signal intensity in the right anterior frontal lobe, possibly a small focal hemorrhagic contusion/calcifying granulomatous lesion 2.
- The presence of anosmia, or loss of smell, can be a symptom of various conditions, including head trauma, viral infections, and neurological disorders.
- Studies have shown that anosmia can be a persistent symptom in some cases, with a study on COVID-19-related anosmia finding that 83% of participants recovered from anosmia within 30 days, but with a median recovery time of 13 days 3.
- Another study on olfactory bulb MRI and paranasal sinus CT findings in persistent COVID-19 anosmia found that olfactory cleft and olfactory bulb abnormalities are common in COVID-19 anosmia, with a relatively high percentage of olfactory bulb degeneration 4.
Treatment and Management
The treatment and management of anosmia depend on the underlying cause and severity of the condition.
- A comprehensive review of the management of anosmia in COVID-19 suggests that olfactory training, topical or oral corticosteroids, caffeine, insulin, or minocycline may be effective in treating COVID-19-related odor loss 5.
- A systematic review of the management of post-infectious anosmia and hyposmia found that intranasal corticosteroids and olfactory training have the most robust data supporting their efficacy, with clinically significant improvements in olfactory functions as measured through validated smell tests 6.
- The patient's prognosis and treatment plan should be determined by a healthcare professional based on individual factors and medical history.