Rapid improvement of olfaction after lumbar puncture in a patient with idiopathic intracranial hypertension.

Idiopathic intracranial hypertension (IIH), also known as pseudotumor cerebri, preferentially affects obese women of childbearing age. Although the precise etiology of IIH remains to be fully established, elevated intracranial pressure (ICP) clearly constitutes a hallmark pathologic feature of the condition. Affected individuals regularly suffer from signs and symptoms of increased ICP such as headache, papilledema, bilateral visual obscurations, sixth nerve palsy, and nausea. Typically, the patient experiences some combination of symptoms that may also fluctuate somewhat over time. Although a ‘positive’ response to a spinal tap should not be regarded as diagnostic on its own, numerous patients experience temporary improvement of complaints after lumbar puncture. It is only very recently that Kapoor first developed the hypothesis that olfactory dysfunction attends IIH. This issue is clinically significant since the sense of smell affects the palatability of food. Moreover, olfactory cues may alert the individual to environmental (eg, dietary) hazards. Even more important, olfaction is heavily involved in interpersonal exchanges and experiences. Not surprisingly, accumulating evidence supports a link between impaired olfaction, depression, and reduced quality of life. We previously reported that approximately 80% of patients with acute clinical manifestations of IIH display hyposmia. Albeit frequently overlooked, this makes hyposmia one of the most prevalent IIH-related symptoms. In the meantime, others have come to similar results. In particular, a From the Charit e Center 15 for Neurology, Neurosurgery and Psychiatry, Charit e-Universit€atsmedizin Berlin, Berlin, Germany (N. Becker, G. Kronenberg, and L. Harms); Department of Radiology, Charit e-Universit€atsmedizin Berlin, Berlin, Germany (E. Wiener and K. Kreutz); NeuroCure Clinical Research Center NCRC, Charit e-Universit€atsmedizin Berlin, Berlin, Germany (A. Eltiri); Charit e Center 15 for Neurology, Neurosurgery and Psychiatry; NeuroCure Clinical Research Center NCRC, Charit e-Universit€atsmedizin Berlin, Berlin, Germany (F. Schmidt and H. Kunte); Department of Systems Neuroscience, University Medical Center HamburgEppendorf, Hamburg, Germany (J. Hoffmann).