Altered taste and stroke: a case report and literature review

Abstract

Patients with altered taste perception following stroke are at risk for malnutrition and associated complications that may impede recovery and adversely affect quality of life. Such deficits often induce and exacerbate depressive symptomatology, which can further hamper recovery. It is important for clinicians and rehabilitation specialists to monitor stroke patients for altered taste perception so that this issue can be addressed. The authors present the case of a patient who experienced an isolated ischemic infarct affecting a primary cortical taste area. This case is unusual in that the isolated injury allowed the patient to remain relatively intact cognitively and functionally, and thus able to accurately describe her taste-related deficits. The case is further used to describe the relevant neurological taste pathways and review potential taste-related therapies.

Figure 1

CT head without contrast performed at approximately 30 hours after symptom onset shows hypodense region within the left anterior insular cortex. The remaining middle cerebral artery (MCA) territory shows normal gray-white differentiation.

Figure 2

Diagram of central taste pathway. Inputs from cranial nerves VII, IX, and X synapse in the medulla in the solitary nucleus. Ascending fibers travel ipsilaterally through the pons to their targets within the thalamus, the ventroposteriormedial (VPM), and dorsomedial (DM) nuclei. The projections from the thalamus are to the insular and orbitofrontal cortex, though the precise routes taken by these tracts are debated in the literature. Reprinted, with permission, from Bermudez-Rattoni F. Molecular mechanisms of taste-recognition memory. Nature Neurosci Rev. 2004;5:209-217. Copyright © Macmillan Publishers Ltd.