Is Rhinorrhea an Under-Recognized Intrinsic Symptom of Parkinson Disease? A Prospective Pilot Study

Sedig, Laura; Leibner, Joshua; Ramjit, Amit; Wu, Samuel S.; Dai, Yunfeng; Okun, Michael S.; Rodríguez, Ramón; Malaty, Irene A.; Fernández, Hubert H.

doi:10.3109/00207451003615755

Cited by 8 publications

(11 citation statements)

References 9 publications

(11 reference statements)

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“…Previous studies have reported that rhinorrhea is more prevalent in patients with PD (24-50%) than in normal controls (6-26%) [2][3][4][5]. Furthermore, 38% of patients with PD with rhinorrhea reported worsening of rhinorrhea while eating [4].…”

Section: Discussionmentioning

confidence: 94%

“…However, the exact pathophysiology is still unclear [1]. Some reports suggest that rhinorrhea occurs more frequently among patients with Parkinson's disease (PD) than among healthy controls [2][3][4][5]. However, these reports are based on questionnaire surveys; detailed findings of rhinorrhea in patients with PD have not yet been reported.…”

Section: Introductionmentioning

confidence: 99%

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Gustatory rhinitis in multiple system atrophy

Yamakawa

Kondo

Unaki

et al. 2021

Acta Oto-Laryngologica Case Reports

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Gustatory rhinitis is a type of nonallergic, noninflammatory rhinitis. A high incidence of rhinorrhea, including gustatory rhinitis, is reported in patients with Parkinson's disease (PD). Herein, we report a case of gustatory rhinitis in a patient with a parkinsonian variant of multiple system atrophy (MSA-P). A 56-year-old man presented with gustatory rhinorrhea and bilateral copious nasal discharge while eating. Three years before visiting the ear, nose, and throat clinic, he developed Parkinsonism and was suspected of having MSA-P. He underwent posterior nasal neurectomy under endoscopic guidance, but it did not significantly reduce the rhinorrhea during eating. Pathological examination of the mucosa of the inferior turbinate demonstrated minimal inflammatory cellular infiltration. Severe (gustatory) rhinitis may also be a useful biomarker for the diagnosis of synucleinopathies, including PD and MSA, akin to anosmia, which is a wellknown biomarker for the early diagnosis of PD.

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Section: Discussionmentioning

confidence: 94%

Section: Introductionmentioning

confidence: 99%

Gustatory rhinitis in multiple system atrophy

Yamakawa

Kondo

Unaki

et al. 2021

Acta Oto-Laryngologica Case Reports

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“…2,3 Patients with DLB have an increased risk of syncope/loss of consciousness, 1 which may be magnified among those with rhinorrhea. 4 Several studies have also substantiated a greater prevalence of rhinorrhea in patients with PD than in healthy controls (table), [2][3][4][5][6] with a range between 24% and 57%. Of interest, however, an association between rhinorrhea (a nondopaminergic feature 4 ) and anosmia (a dopaminergic one), a wellestablished premotor deficit in PD, was confirmed by only 1 6 of the 5 case-controlled studies examining such relationship.…”

Section: Discussionmentioning

confidence: 99%

“…Of interest, however, an association between rhinorrhea (a nondopaminergic feature 4 ) and anosmia (a dopaminergic one), a wellestablished premotor deficit in PD, was confirmed by only 1 6 of the 5 case-controlled studies examining such relationship. Further, rhinorrhea-affected patients with PD displayed no correlation with motor and nonmotor clinical variables in studies [4][5][6] that explored these parameters.…”

Section: Discussionmentioning

confidence: 99%

“…1 Case-control studies have reported a higher prevalence of rhinorrhea in patients with Parkinson disease (PD) compared to healthy controls. [2][3][4][5][6] Of interest, 76% of patients with PD reported rhinorrhea exacerbation while eating. 2 Further studies have corroborated a 5-fold increased prevalence of rhinorrhea in patients with PD compared to controls and also an association with lightheadedness among rhinorrhea-affected patients with PD.…”

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confidence: 99%

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Runny nose sign

Sokol

Espay

2016

Neur Clin Pract

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D ementia with Lewy bodies (DLB) is characterized by a triad of core features: fluctuating cognition, visual hallucinations, and parkinsonism; other commonly associated features include REM sleep behavior disorder (RBD) and dysautonomia (e.g., orthostatic hypotension, urinary incontinence, constipation, and impotence).1 Case-control studies have reported a higher prevalence of rhinorrhea in patients with Parkinson disease (PD) compared to healthy controls.2-6 Of interest, 76% of patients with PD reported rhinorrhea exacerbation while eating.2 Further studies have corroborated a 5-fold increased prevalence of rhinorrhea in patients with PD compared to controls and also an association with lightheadedness among rhinorrhea-affected patients with PD. 4 We report a patient with clinically probable DLB who presented with activity-dependent rhinorrhea consistently followed by hypotensive syncope, suggesting that the rhinorrheahypotension association may be temporally closer than previously suspected, and highlighting the value of nonpharmacologic therapeutic strategies in this clinical situation. Case reportAn 85-year-old Ashkenazi Jewish man, type 1 N370S Gaucher disease (GBA) carrier, with history of peripheral neuropathy, hyperlipidemia, and coronary artery bypass grafting, complicated by hypotension at age 74, and dream enactment behaviors suggestive of RBD, presented with a 5-year history of tremorless parkinsonism with visual hallucinations and fluctuating cognition at symptom onset, followed by orthostatic hypotension, meeting McKeith criteria for clinically probable DLB.1 The patient denied a history of anosmia, diabetes, allergies, nasal, or sinus complaints. Eating, urinating, and defecating consistently induced rhinorrhea, followed by hypotensive syncope within minutes. Blood pressure (BP) during these events was documented to be as low as 60/40 mm Hg. However, his BP markedly fluctuated throughout the day, with readings as high as 180/100 in the sitting position.Trials of nasal spray were futile. Carbidopa/levodopa exacerbated the hypotensive syncope and hallucinations and thus was discontinued. He refused separate trials of rivastigmine and quetiapine. To exclude CSF as the source of rhinorrhea, given that some triggering activities were associated with Valsalva-type actions, the patient's nasal discharge was examined for b-2 transferrin, which was negative. None of the patient's medications was known to have previously induced rhinorrhea and syncope.The family referred to the sequential events of rhinorrhea and hypotensive syncope as the runny nose sign (video at Neurology.org/cp), and considered it his most disabling feature. Efforts at optimizing the dosage of fludrocortisone and midodrine did not reduce the frequency of these episodes. The patient would secrete copious clear, thick nasal discharge, invariably announcing hypotensive syncope within minutes. Rhinorrhea would continue Practical ImplicationsConsider administering a vasopressor prior to activities that generate syncope and substantial disabi...

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