Loss of smell in patients with COVID-19: MRI data reveal a transient edema of the olfactory clefts

Neurology. 2020 Dec 8;95(23):e3145-e3152. doi: 10.1212/WNL.0000000000010806. Epub 2020 Sep 11.

Abstract

Objective: To assess the physiopathology of olfactory function loss (OFL) in patients with coronavirus disease 2019 (COVID-19), we evaluated the olfactory clefts (OC) on MRI during the early stage of the disease and 1 month later.

Methods: This was a prospective, monocentric, case-controlled study. Twenty severe acute respiratory syndrome coronavirus 2 (SARS-CoV2)-infected patients with OFL were included and compared to 20 age-matched healthy controls. All infected patients underwent olfactory function assessment and 3T MRI, performed both at the early stage of the disease and at the 1-month follow-up.

Results: At the early stage, SARS-CoV2-infected patients had a mean olfactory score of 2.8 ± 2.7 (range 0-8), and MRI displayed a complete obstruction of the OC in 19 of 20 patients. Controls had normal olfactory scores and no obstruction of the OC on MRI. At the 1 month follow-up, the olfactory score had improved to 8.3 ± 1.9 (range 4-10) in patients, and only 7 of 20 patients still had an obstruction of the OC. There was a correlation between olfactory score and obstruction of the OC (p = 0.004).

Conclusion: OFL in SARS-CoV2-infected patients is associated with a reversible obstruction of the OC.

MeSH terms

  • Adult
  • Anosmia / diagnosis*
  • Anosmia / etiology*
  • Anosmia / pathology
  • Anosmia / physiopathology
  • COVID-19 / complications*
  • COVID-19 / diagnostic imaging
  • COVID-19 / pathology
  • COVID-19 / physiopathology
  • Case-Control Studies
  • Edema / diagnostic imaging
  • Edema / etiology
  • Edema / pathology*
  • Female
  • Follow-Up Studies
  • Humans
  • Magnetic Resonance Imaging
  • Male
  • Middle Aged
  • Nasal Cavity / diagnostic imaging
  • Nasal Cavity / pathology*
  • Nasal Obstruction / diagnostic imaging
  • Nasal Obstruction / etiology
  • Nasal Obstruction / pathology*
  • Young Adult