D I S T U R B A N C E OF T A S T E A S A S Y M P T O M OF MULTIPLE SCLEROSIS

LAWRENCE COHEN, F.D.S.R.C.S., L.R.C.P., M.R.C.S. Department of Oral Medicine, Institute of Dental Surgery (University of London),

Eastman Dental Hospital, Gray's Inn Road, London, W.C.I

MULTIPLE (disseminated) sclerosis is a disorder of the central nervous system of unknown aetiology often characterised by remissions and relapses. I t is slightly more common in females than males and is more frequent in the northern hemi- phere. The significance of this is unknown. The disease begins commonly in early to middle adult life. In most of the cases the onset of symptoms is between the ages of 20 and 4 ° years.

P a t h o l o g y . - - T h e lesions of multiple sclerosis consist of sharply circum- scribed plaques of demyelination and gliosis scattered mainly in the white matter throughout the central nervous system.

Clinical Mani fes tat ions . - -The condition may begin suddenly with dimness of vision in one eye, weakness or paraesthesia of a single limb or of the face, or clumsiness in the use of a hand. The symptoms may clear and be followed by a period of months or years during which t ime the patient feels perfectly well. Another form is more rapid in its course and produces paralysis or severe weakness of limbs or widespread anaesthesia and paraesthesia with speech and bladder difficulties. In some cases there is a rapid downhill course leading to death of the patient.

Disturbance of taste in multiple sclerosis is a rare symptom. Mfiller (1949) in a study based on 81o cases of multiple sclerosis seen between 1945-9 only met with disturbed taste in eleven cases two of which had simultaneous facial paresis. McAlpine, Compston and Lumsden (1955) in discussing disturbance of taste in multiple sclerosis state that occasionally it is associated with Bell's palsy or with sensory disturbance in the distribution of the fifth cranial nerve but they have seen it occur without any facial signs.

T h e following case report is of interest because the patient lost her sense of taste on two occasions.

CASE R E P O R T

The patient was a young married woman aged 21 years who was referred by her dental surgeon because of loss of taste on two separate occasions.

In her previous medical history it was noted that at the age of 15 years she had fractured her skull in the frontal region but there were no symptoms following recovery.

History of present compla in t . - -Three months before her referral to hospital the patient noticed a 'funny taste' in her mouth. The left side of the tongue was first affected and then she noticed that all sense of taste apart from that of salt was lost. This recovered gradually after about two weeks and taste was unimpaired for about two months. Suddenly the sense of taste was lost for a second time to return again after about one month. At the beginning and the end of each episode the patient noticed a nasty taste in the mouth.

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DISTURBANCE OF TASTE AS A SYMPTOM OF MULTIPLE SCLEROSIS 185

Two months prior to examination she noticed a sensation of tingling and numbness of the left hand. The left upper limb became weak and stiff and sometimes she dropped things from it. In consequence, she had to give up her job as a typist.

She had noticed occasional difficulty in micturition for two to three weeks at one stage in her illness.

On examination the patient was rather tense and nervous. There was no abnormality of speech and the eye movements and optic discs were normal. Sensibility to pinprick and light touch was impaired on the left side of the face and pinprick sensation was impaired on the left side of the tongue. There was no impairment of taste. The left corneal reflex was diminished. Cranial nerve function was otherwise normal.

There was slight weakness and impairment of sensibility to pinprick of the left upper limb, and slight clumsiness in the use of the left hand. The right biceps jerk was brisker than the left but the knee jerks and ankle jerks were all brisk and equal. Abdominal reflexes were present. Although the right plantar response was flexor the left was shown to be extensor.

These symptoms suggested a diagnosis of multiple sclerosis and this was confirmed by a neurologist.

When seen again two months later all her symptoms had disappeared and there were no abnormal neurological findings.

A C K N O W L E D G E M E N T S

I am grateful to Professor R. Bradlaw and Dr. Nigel Compston for their help in the preparation of this paper.

REFERENCES

MCALPINE, D., COMPSTON, N. D. ~ LUMSDEN, C. E. (1955). Multiple Sclerosis, p. 99. Edinburgh: Livingstone.

Mt3LLER, R. (1949). Studies on disseminated sclerosis with special reference to symptomatology, course and prognosis. Acta med. scand. Suppl. 222, 7o.