Elsevier

The Journal of Pediatrics

Volume 128, Issue 2, February 1996, Pages 296-301
The Journal of Pediatrics

Reversibility of cerebral ventricular enlargement in anorexia nervosa, demonstrated by quantitative magnetic resonance imaging,☆☆,

Presented in part at the Society for Pediatric Research, San Diego, Calif., May 6-11, 1995.
https://doi.org/10.1016/S0022-3476(96)70414-6Get rights and content

Abstract

OBJECTIVE: To determine the reversibility of the loss of brain parenchyma and ventricular enlargement in patients with anorexia nervosa after refeeding. STUDY DESIGN: Quantitative magnetic resonance imaging was performed on three groups of subjects: (1) 12 female adolescents hospitalized with anorexia nervosa, (2) the same 12 patients after nutritional rehabilitation, a mean of 11.1 months later, and (3) 12 healthy age-matched control subjects. Sixty-four contiguous coronal magnetic resonance images, 3.1 mm thick, were obtained. With a computerized morphometry system, lateral and third ventricular volumes were measured by a single observer unaware of the status of the patient. RESULTS: On admission, patients were malnourished and had lost an average of 11.7 kg (body mass index, 14.3 ± 2.0 kg/m2). After refeeding, they gained an average of 9.7 kg (body mass index, 17.9 ± 1.5 kg/m2). Total ventricular volume decreased from 17.1 ± 5.5 cm3 on admission to 12.4 ± 3.0 cm3 after refeeding (p <0.01) and returned to the normal range. The degree of enlargement of the third ventricle was greater than that of the lateral ventricles. There was a significant inverse relationship between body mass index and total ventricular volume (r = -0.63; p <0.05). CONCLUSION: In patients with anorexia nervosa, cerebral ventricular enlargement correlates with the degree of malnutrition and is reversible with weight gain during long-term follow-up. (J PEDIATR 1996;128:296-301)

Section snippets

Subjects

The study population consisted of 12 female adolescents with anorexia nervosa who agreed to undergo an additional magnetic resonance imaging scan after weight gain. The subjects were 11 to 21 years of age (mean, 16.1 ± 3.0 years) who were admitted to the Schneider Children's Hospital Eating Disorders Center for nutritional rehabilitation. All patients met the criteria of the Diagnostic and Statistical Manual of Mental Disorders (third edition, revised)12 for anorexia nervosa and had lost an

RESULTS

Patients and control subjects were of similar age, 16.1 ± 3.0 and 16.3 ± 3.3 years, respectively, but those with anorexia nervosa had lower weight, a lower percentage of ideal body weight, and lower BMI (Table). At baseline, total ventricular volume in adolescents with anorexia nervosa was significantly higher than in the control subjects: 17.1 ± 5.5 cm3 vs 11.7 ± 4.3 cm3 (p <0.01) (Fig. 1). Compared with control subjects, the degree of enlargement of the third ventricle in subjects with

DISCUSSION

Structural brain changes similar to those found in our patients are seen in children with kwashiorkor15 and in adults with schizophrenia,16, 17, 18 alcoholism,19 or Cushing syndrome,2, 20 and those taking corticosteroids.21

Neuropsychologic testing of patients with anorexia nervosa has revealed impairment of attention and concentration and deficits in visuospatial abilities, visual associative learning, and perceptual motor functioning.5, 22, 23, 24, 25, 26, 27 These deficits are subtle and

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    From the Department of Pediatrics, Division of Adolescent Medicine and Department of Radiology, Division of Neuroradiology, Schneider Children's Hospital of Long Island Jewish Medical Center, Albert Einstein College of Medicine, New Hyde Park, New York

    ☆☆

    Reprint requests: Neville H. Golden, MD, Division of Adolescent Medicine, Room 187, Schneider Children's Hospital of Long Island Jewish Medical Center, New Hyde Park, NY 11042.

    0022-3476/96/$5.00 + 0 9/27/70005

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