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Dr. Andrew Rynne

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What causes severe anxiety while suffering from insomnia?

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Dr. Olsi Taka

Neurologist

Practicing since :2004

Answered : 3601 Questions

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Posted on Mon, 3 Apr 2017 in Brain and Spine
Question: Approximately 3 months ago I suffered a concussion. I have had post concussion symptoms like insomnia and anxiety, but in the last couple of days i have noticed a sweet floral cleaning smell. I have nothing around like this and someone said I should get this checked out. Do you know what this could be and should i be concerned.
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Answered by Dr. Olsi Taka 1 hour later
Brief Answer:
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Detailed Answer:
I read your question carefully and I understand your concern.

Changes in the sense of smell can at times represent medical issues. However usually they are in the form of bad odors, it is very very uncommon to manifest with a pleasant smell as you describe.
Most common cause of alteration of smell is a case of upper airway infection such as rhinitis or sinusitis. Infections of the oral cavity may also lead to smell changes. So in case you have symptoms like congested nose or teeth and gum issues those may be considered first.
When it comes to neurological causes brain trauma may at time cause damage to olfactory nerve and cause smell changes. That should occur earlier than 3 months after the trauma though. Some rare tumors affecting the olfactory (smelling) nerve may be a cause as well. So If persistent a MRI may be scheduled. However I wouldn't really be too concerned, as I said usually in the form of bad smells, most probably MRI would turn out alright.

I remain at your disposal for other questions.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Follow up: Dr. Olsi Taka 25 minutes later
Hello! Thank you for your reply. I just thought of some other information that came to mind after reading your answer. When I first had the concussion, I had lost all sense of taste and smell and over the last while I have been able to taste more foods and liquids as well as start to smell more foods, liquids, soaps etc, but initially all I could smell was like a cardboard smell. The other thing was that yesterday I went to massage (it was suggested I go once a week as I had also gotten a bit of whip lash) and the massage therapist massage my neck, scalp, and a bit around my forehead down onto may face and around my nose and cheeks. I noticed the smell the most last night and this morning. Could the massage add to this or could it be that my smell may be coming back a bit more. I don't know what to think, but the smell is not bad it just seems very perfumey, but annoying at the same time. This smell change when I really think about it has really only been obvious yesterday and today, otherwise my smell and taste have been coming back gradually. I did have a bit of a minor cold last week, but it has otherwise been good, but I do cry a lot and blow my nose a lot. I have found the post concussive symptoms very hard and have not been sleeping that well in conjunction with anxiety and now to top it off I smell perfume. Also for the anxiety I have tried amitriptyline (which made me feel extremely weird) and Effexor (which made me seem very drunk from a 37.5 mg dose). At the present time I am not taking anything and just trying to rest, do breathing and exercises. Is there anything else you could recommend as I want to make sure that I will heal my brain to the best of my ability, but sometimes it is hard to shut off the anxiety.
Thank you for your time. Also for the anxiety I have tried amitriptyline (which made me feel extremely weird) and Effexor (which made me seem very drunk from a 37.5 mg dose). At the present time I am not taking anything and just trying to rest, do breathing and exercises. Is there anything else you could recommend as I want to make sure that I will heal my brain to the best of my ability, but sometimes it is hard to shut off the anxiety.
Thank you for your time. Also, will this smell go away. It is quite strong.As mentioned earlier, will the smell go away and it is quite strong. Could this be a result of the massage to the face and neck and did damage occur (is this why I have this smell).
doctor
Answered by Dr. Olsi Taka 4 hours later
Brief Answer:
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Detailed Answer:
Thank you for the additional information.

The fact that you had lost your sense of smell after the trauma may have something to do with it. In that case the trauma may have damaged the olfactory nerve fibers and now as the nerve is regenerating itself as new connections are created to substitute for the disrupted ones some changes in smell may appear.

On the other hand the anxiety issue makes it a little difficult to be absolutely sure that is the case as anxiety at times may mimic such symptoms as well. Regarding anxiety treatment I feel the doctors have tried the correct options in terms of medications, both amitriptyline and venlafaxine (Effexor) are good choices. If one is to try another option a SSRI like escitalopram may be tried. For the rest you are doing the right things, rest, breathing relaxation maneuvers and moderate exercise are the correct approach. Psychotherapy sessions if not already done are advised. Activities like yoga may also be of help.

Whether the smell can go away...one can't say that with certainty, but hopefully if the trauma is the cause as the nerve regeneration process completes itself in the next three months the issue will improve.

As for the massage question, the answer is no, massage doesn't affect smelling function, I believe it is a coincidence.

Let me know if I can further assist you.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Follow up: Dr. Olsi Taka 33 hours later
Just wanted to let you know that the smell has stronger and stronger and it is now all encompassing. When I breathe through my mouth or nose I can smell it and taste it. What do you suggest at this point. Should I be concerned and what should I follow up with.Sorry the smell has gotten stronger and stronger. I am concerned. I don't know what to do at this point. The smell also wakes me up when I'm sleeping as I sleep with a cpap machine and the smell fills the mask and I have to remove it.
doctor
Answered by Dr. Olsi Taka 7 hours later
Brief Answer:
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Detailed Answer:
Hello again.

In terms of it being a manifestation of something worrying in the absence of any other symptoms I do not see any cause for panic, at least in the sense that the hypotheses remain the same. If anything I would call the possibility of a tumor even less likely now as does not change this quickly, it would be more indicative of anxiety.
Perhaps a medication like Gabapentin might be considered as it would be indicated both for the possibility of the damage to the olfactory nerve from the trauma as well as might help with anxiety.
If not improving I would schedule a MRI, but I would be optimistic nothing major will turn out, as I said lesions like tumors affecting olfactory nerve usually manifest with bad odor sensation and wouldn't change this quickly.

I hope you'll feel better soon.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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