COVID-19 Anosmia and Lacunar Stroke.

Abstract Background: Despite the worldwide COVID-19 vaccination programme, there is not enough information to predict when the current pandemic will end, and new variants of SASR-CoV-2 are travelling worldwide, leading to the new variability of clinical manifestation, complications and increasing fatal outcomes. Many publications on COVID-anosmia and asymptomatic COVID-stroke have been released, and plenty of studies on novel therapeutic approach have been published. Here we report an atypical case, our findings from review the medical literature, and comment on the treatment modalities. Material and Method: EMBASE, Medline, Scopus online databases, Google Scholar, Science Direct, WHO database, Scielo, LILACS, BIREME, and Cochrane library to identify articles evaluating anosmia*, COVID-19 anosmia*, aetiology of anosmia*, lacunar infarct*, treatment of IS*, and COVID-19 acute stroke* from January 1, 2010, to March 30, 2021.Results: We found 2454publications related to these topics. After removing duplicate articles, considering the title and abstracts, screening full text, PCR positives, symptomatic patients, and manuscript written in other languages, only six matches all the selected parameters, but from this group, none one presented COVID anosmia/PCR negative/ No respiratory disturbances/presence of IgG/ lacune larger than 15 mm (macunes).Case presentation: A 17-years-old male came to the medical outpatient clinic complaining of loss of smell without other symptomatology. The PCR test for SARS-Cov-2 done was negative, and then he did not receive COVID-19 treatment. Four weeks later patient back to the hospital because of no improvement and was admitted to the hospital neurology ward. Apart from anosmia, examination of other systems shows unremarkable findings. We did an extensive serological and CSF work-up to exclude almost all causes of anosmia. Brain MRI confirmed focal oval cyst space with CSF signal measuring 17 mm in the external capsule in the left basal ganglia region like a lacune (macune) from a previous vascular insult.Comments and final remarks: After an extensive literature review of published manuscript related to these topics, we did not find a report like our case, which presented COVID-19 anosmia/ without respiratory symptomatology/silent macune stroke/PCR negative with positive antibodies, apart from the systematic review of published articles related to these issues. We also included an updated list of anosmia aetiology and the recommended treatments for LS published in the medical literature.