Author: Helen Yasmin Sultan / Editor: Adrian Boyle / Code: MHC1, SLO4, TP1Published: 10/12/2013

A 19-year-old man attends the ED complaining of a change in his sense of smell and taste, together with a feeling of pressure behind the eyes.

Five days previously, he apparently fell and hit his head in a nightclub while on holiday with friends. He has no memory of this, but had been drinking heavily. No-one remembers whether he lost consciousness. He is otherwise asymptomatic (in particular, no nausea, no headache, no seizures, no otorrhoea or rhinorhoea) and has no other medical history. His family say his behaviour is normal. He does not take any medications.

Cranial nerve examination was normal except for subjectively reduced smell and taste (no equipment available for formal testing). The eardrums were not visualised due to wax in the ear canals.

The remainder of the examination (CNS, scalp and neck) was normal.