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[A case of unilateral gustatory disturbance produced by the contralateral midbrain lesion].

We reported a case of unilateral gustatory disturbance produced by a lesion in the contralateral midbrain. A 37-year-old man first noticed dysesthesia in the left side of his face. Later, the patient developed dysesthesia of the left part of the lip, muscular weakness on the left lower extremity and gustatory disturbance on the left side. MR scan disclosed a lesion in the tegmentum of the right midbrain, which showed low intensity on a T1-weighted image and high intensity on a T2-weighted image. This lesion could be due to multiple sclerosis. This case suggests that the unilateral gustatory information ascends via the contralateral pathway at the midbrain level. It is suggested that the central gustatory pathways above the ipsilateral pontine taste are ascend via the contralateral projections to the thalamic taste area (parvicellular portion of the ventral posteromedial thalamic nucleus, VPMpc).

Adult↗

[Genetic and environmental factors in normal and deviant dietary behavior of the child].

The alimentary behaviors of the child are approached from a developmental point of view, the genesis and the evolution of normal behavior allowing us to better understand the origin, the causality and the signification of pathological behaviors. In this perspective the study, in particular, of the evolution of the taste sensation and its ties with the development of personality permits better to understand the problem. Taking in account actually directions of research and some original works, several directions of study are presented, connected with the following aspects: topological and functional evolution of taste receptors, developmental evolution and individual differentiation of the gustatory sensation, hereditary determinants of gustatory sensation and their possible relations with other aspects of personnality, ethological, cultural and environmental (both, in the large and restrictive meaning) aspects and their place in reinforcements of alimentary behavior. A line of research, which overgoes the only descriptive point of view and has an explanatory aim, is proposed, inserted in a real context.

Child↗

[Temporal-lobe epilepsy with psychosensory and gustatory attacks].

A variety of temporal epilepsy that manifested by paroxysms in the form of psychosensory and gustatory ones is described. A 20-year-old man was placed under observation. Since 14 years of age he demonstrated attack-like conditions with a sensation of the pushing apart and swelling in the head, of an increase of the head size, and unpleasant sickly sweet taste in the mouth. The attacks were accompanied by anxiety and general weakness. Neurological examination revealed left-handed hemisymptomatology, EEG demonstrated activity prevailing in the occipitotemporal leads on the right. The neuropsychological findings attested to the impairment of the structures of the right temporal lobe. Analysis of the clinical manifestations of epilepsy, of the neurological findings, and the neuropsychologist's conclusion made it possible to suggest the site of the epileptic focus in the field of the hippocamp on the right.

Adult↗

[A 46-year-old woman with myasthenia gravis associated with macromastia, erythroderma and hypogeusia].

A 46-year-old woman developed blepharoptosis, diplopia and hypogeusia in 1984, and was diagnosed as having myasthenia gravis and malignant thymoma. Her symptoms improved by thymectomy and oral prednisolone administration. In 1988 she complained of breast pain and swelling during menstruation. In 1990 her breast was enlarged to the size of an adult head, and she developed erythroderma and hypogeusia. She was admitted to Nagasaki University Hospital in August, 1990. On admission, erythema was seen in the whole body especially in the face, anterior chest, abdomen and the thigh. Her breast was the size of an adult head. Muscle strength was weak, and ocular movement was limited. She had blepharoptosis. Papillae of the tongue were atrophic. Endoclinological investigations revealed an elevation of PRL to 14.6 ng/ml (normal < 10), antibodies to the acetylcholine receptor to 118.0 nM (normal < 0.5). In TRH stimulation test the response of PRL was amplified. Four intrathoracic masses suspected of recurrence of malignant thymoma were seen in CT. Her macromastia depended upon the amount of PRL, and was reduced by bromocriptine. Erythroderma and hypogeusia were relieved by plasmaphersis. Therefore autoimmune mechanism may be related to these symptoms.

Breast↗

[Ipsilateral gustatory disturbance by thalamic hemorrhage].

Animal studies have recently demonstrated that the gustatory pathway ascends in the brainstem ipsilaterally without crossing, and terminates in the ipsilateral lower caudal limit of the thalamus, i.e., the nucleus ventralis posteromedialis parvocellularis (VPMpc). However, little is yet known about the corresponding anatomical arrangement in man. Some clinical reports on cases of ipsilateral gustatory disturbance caused by tegmental pontine hemorrhage have suggested that the human gustatory pathway may also ascend ipsilaterally in the brainstem. Our case is a 35-year-old man, who was admitted to the hospital because of double vision. Computed tomography revealed a small high density area in the right paramedian tegmentum of the upper midbrain. On the 7th hospital day, the patient suddenly complained of dysesthesia on the right side of the oral cavity. Neurological examination demonstrated remarkable total hypogeusia on the right side of the tongue. MR imaging revealed upward extension of the hematoma toward the lower caudal portion of right thalamus. This is first report to demonstrate unilateral gustatory disturbance due to lesion in the ipsilateral thalamus. It is also worth of note that unilateral gustatory disturbance caused by thalamic lesion can be accompanied by sensory impairment in the ipsilateral oral cavity.

Adult↗

[Taste disturbance as an initial manifestation of Guillain-Barré syndrome in a 14-year-old girl].

We reported a 14-year-old girl who showed taste disturbance as an initial manifestation of Guillain-Barré syndrome (GBS). After an upper respiratory infection, she initially complained of taste disturbance, diplopia and salivation, followed by weakness in the legs and numbness in the extremities. On admission, she showed taste deficiency for sweet and sour sense, and a decline of salty and bitter taste. Weakness in the legs and disappearance of deep tendon reflexes were also noticed. We considered that the findings of electrophysiological examinations would conform to demyelinating features. Laboratory examinations revealed an increase of memory T cells in the peripheral blood and an elevated level of myelin basic protein in the cerebrospinal fluid. Based on clinical features and laboratory data, the diagnosis of GBS was made. We should keep taste disturbance in mind as one of the signs of GBS.

Adolescent↗

Oral manifestations of diabetes mellitus in controlled and uncontrolled patients.

The authors studied the oral manifestations of a sample of 70 diabetic patients, divided into controlled and uncontrolled patients. Medical history and stomatological data were analyzed and diabetic controlled patients were matched to uncontrolled patients. The main symptoms observed were hyposalivation, taste alterations and burning mouth, with the main sign being parotid enlargement. The lesions observed were candidosis of the erythematous type and proliferative lesions both associated to the use of total prosthesis. No pathognomic lesions or alterations could be observed in relation to the disease. The frequency of carriers of Candida albicans and also the lesions observed could be compared to normal patients also using total dentures.

Candidiasis, Oral↗

Xerostomia: diagnosis and management.

Xerostomia, or dry mouth, is a common complaint that may be caused by several conditions, which include side effects of a wide variety of drugs, such as antidepressants, therapeutic radiation to the head and neck, dehydration, diabetes, and diseases involving salivary glands, such as Sjögren's syndrome. The complaint of dry mouth may or may not be associated with decreased salivary gland function. Individuals with xerostomia complain of problems with eating, speaking, swallowing, and wearing dentures. Some people also complain of salivary gland enlargement or changes in taste. Lack of saliva may predispose one to oral infections, such as candidiasis, and increase the risk of dental caries. Management of the individual patient with xerostomia includes assessment of salivary gland function, replacement therapy, and prevention of caries and oral candidiasis. Early recognition and management of xerostomia may prevent devastating dental disease and help to improve the quality of life.

Antidepressive Agents↗

Ramsay Hunt syndrome presenting as a cranial polyneuropathy.

Ramsay Hunt syndrome is herpes zoster of the facial nerve, frequently associated with VIII cranial nerve involvement, but on rare occasions V, VI, IX, and X cranial nerves are affected as well. We present a case of a Ramsay Hunt syndrome with involvement of V, VII, and VIII cranial nerves.

Acyclovir↗

Bismuth subsalicylate instead of metronidazole with lansoprazole and clarithromycin for Helicobacter pylori infection: a randomized trial.

OBJECTIVE: We evaluated the efficacy of lansoprazole, clarithromycin, and metronidazole (LCM) administered twice daily for 7 days. Because there is growing concern about the development of metronidazole-resistant H. pylori (HP) strains, we also tested a novel regimen consisting of lansoprazole, clarithromycin, and bismuth subsalicylate (LCB). METHODS: Patients with active HP infection and peptic ulcer, a history of peptic ulcer, or nonulcer dyspepsia were randomized to either lansoprazole 30 mg b.i.d., clarithromycin 500 mg b.i.d., and metronidazole 500 mg b.i.d. or lansoprazole 30 mg b.i.d., clarithromycin 500 mg b.i.d., and bismuth subsalicylate 524 mg b.i.d. (LCB) for 7 days. Compliance and side effects were recorded by using a diary. RESULTS: "Per protocol" eradication with LCM was achieved in 41 of 47 (87%). By using "intention to treat" analysis, LCM eradicated HP infection in 43 of 53 patients (81%). By using "per protocol" analysis, LCB eradicated HP infection in 40 of 47 patients (85%). On an "intention to treat" basis, LCB led to HP eradication in 42 of 52 (81%). The most common significant side effects observed with LCM were altered taste (39%) and abdominal pain (19%). With LCB, the most common significant side effects were altered taste (23%) and dark stools (23%). CONCLUSIONS: LCB for 7 days was as effective in eradicating HP infection as a 7-day course of LCM. Further studies evaluating the role of bismuth compounds in proton-pump inhibitor based triple therapy are warranted. Such therapy may have particular importance in areas where high metronidazole resistance is a concern.

2-Pyridinylmethylsulfinylbenzimidazoles↗

Taste: the neglected nutritional factor.

Scientists now think that every taste bud has some degree of sensitivity to all the primary taste sensations. The brain detects the type of taste by the ratio of stimulation of different taste buds. Many different substances have flavor-enhancing capacity, including ingredients that represent the primary tastes. Medications, chronic disorders, and radiation therapy can alter taste perception, resulting in loss of appetite. Individualizing nutrition advice, with consideration of taste, health needs, and personal preferences, is a "signature dish" of quality dietetics practice.

Aged↗

Chorda tympani trauma--how much does it affect taste?

The chorda tympani nerve runs just beneath the tympanic membrane, and is often traumatised or sacrificed during middle ear surgery. There is varied opinion as to whether surgeons should preserve this nerve, risking trauma to it in the process, or cleanly sacrifice it, which some authors claim produces less trauma and less troubling dysgeusia. We studied 31 patients retrospectively to document their taste change following middle ear surgery, and found that in many instances, taste change caused by the operation recovered in the course of time. However, when the chorda was sacrificed, there was a 31% increased incidence of permanent taste change.

Chorda Tympani Nerve↗

[Reduced sense of taste as a complication of the laryngeal mask use].

We report a unilateral lingual nerve paralysis following the use of a laryngeal mask airway in a 73-year-old man with hypertrophy of the prostate undergoing a TUR-P. The operation was performed in general anaesthesia using propofol, fentanyl, alfentanil and ventilation with 100% oxygen. The operation was uncomplicated and had a duration of two hours and twenty minutes. A week later the patient perceived a reduced sense of taste. Six months later the situation was unaltered.

Aged↗