James H. Lau, MD
Resident, PGY-3
University of North Carolina at Chapel Hill
Chapel Hill, North Carolina, United States
Kevin Carneiro, DO
Associate Professor
University of North Carolina at Chapel Hill
Chapel Hill, North Carolina, United States
Frontal lobe encephalomalacia secondary to mild traumatic brain injury (mTBI).
Case Description:
A previously healthy 22-year-old female sustained an mTBI without loss of consciousness after hitting her posterior head from a fall off a motorized scooter. CT head without contrast identified a nondisplaced fracture of the right occipital bone without intracranial injury. 2 months later, patient presented to outpatient concussion clinic with dizziness, anosmia, and ageusia. She denied cognitive deficits, vision changes, or seizures. On examination, patient exhibited difficulty with ocular convergence at 10cm and positive Romberg sign. She did not have any focal deficits and Dix-Hallpike was negative. She was referred to vestibular therapy.
At follow-up, patient’s vestibular symptoms resolved, but she continued to suffer with anosmia and her ageusia developed into dysgeusia. Orbital, face, and neck MRI with and without contrast identified encephalomalacia in the bilateral medial frontopolar regions. The left olfactory nerve was slightly smaller than the right side. Patient was referred to olfactory retraining therapy and Otolaryngology.
Discussions:
This is a rare case of encephalomalacia secondary to mTBI that specifically affects the bilateral frontopolar regions. Despite the location of injury, the patient only exhibited dysgeusia without any residual cognitive deficits. Additionally, she had no intracranial damage around her right occipital bone, which was the point of impact.
Conclusions:
Frontopolar encephalomalacia is a rare mTBI sequelae that can cause dysgeusia.
