The Food Critic Who Couldn't Taste and 6 Other Cases of Dysgeusia in Multiple Sclerosis (P06.178)

Objective: Describe clinical, neuro-anatomic, and MRI correlates of dysgeusia (distortion of taste) in multiple sclerosis (MS). Background Dysgeusia is an uncommon symptom of MS; it may be underreported by patients and underappreciated by physicians. Taste sensation is conveyed by CN VII, IX, and X to the solitary tract/nucleus (medulla), up the ipsilateral central tegmental tract (pontine tegmentum), to the VPM thalamus, and on to the cortex. Given this, dysgeusia in an MS patient may portent an ipsilateral brainstem lesion. Design/Methods: Retrospective case series, consisting of seven patients presenting with dysgeusia to our MS center from 2007 to 2011. Clinical and MRI data was collected from electronic medical records. Results: A 40 yo man, a prominent food and wine critic, developed decrease in taste (hypogeusia) of his left tongue. He described utilizing the right side of his mouth “to get the taste information.” MRI identified a demyelinating lesion of the ipsilateral left brachium pontis and left cerebellar peduncle, plus other characteristic MS lesions. Hypogeusia resolved over 3 months. 15 months later, another brainstem relapse occurred resulting in disability. We present 6 additional cases with neuroimaging. Age ranged from 19 to 42. 4/7 were female. 4/7 experienced left sided hypogeusia and 3/7 experienced non-lateralized dysgeusia. Four of these attacks represented the initial demyelinating event, one of which was exclusively left hypogeusia. Dysgeusia lasted from 2 weeks to 3 months. Imaging revealed demyelinating lesions of left brachium pontis in 6/7 patients and right dorsal midbrain in one. 6/7 patients were diagnosed with relapsing remitting MS while one had CIS from a left brachium pontis lesion. Conclusions: Dysgeusia may be the initial presenting symptom of MS. Despite an excellent prognosis for symptomatic recovery, its presence indicates a brainstem attack, a known poor prognostic sign for MS. Patients with laterality to their hypogeusia had corresponding ipislateral brainstem demyelinating lesions. Disclosure: Dr. McGraw has received personal compensation for activities with Biogen Idec. Dr. Krieger has received personal compensation for activities with Acorda Therapeutics, Bayer HealthCare, Biogen Idec, Serono, Inc., Genzyme Corporation, Novartis, Teva Neuroscience as a consultant and/or participant on Pharmaceuticals Corporation. Dr. Wong has nothing to disclose. Dr. Fabian has received personal compensation for activities with Biogen Idec as a speaker.