Reversible and non-reversible enlargement of cerebrospinal fluid spaces in anorexia nervosa

Abstract

Brain CT studies of 35 patients with anorexia nervosa confirmed the observations of other authors: cerebral dystrophic changes correlate with weight loss and the reversibility of these changes also correlates with the normalization of body weight. Other corroborated facts are: the most numerous and most pronounced enlargements are of the cortical sulci and the interhemispheric fissure, moderate widening affects the ventricles and the rarest and most insignificant changes are those of the cerebellum. The reversibility of the changes showed a parallel to the extent of the changes themselves and to the duration of improvement of the body weight. The reversibility of the enlargement of the cortical sulci and of the distances between the frontal horns of the lateral ventricles was more often significant than that of the abnormal measurements of the cella media. This difference is based on minimal early acquired brain damage which occurs in 60% of our patients. This high incidence of early acquired minimal brain disease in patients with anorexia nervosa is here discussed as a nonspecific predisposing factor. Although there is no exact explanation of the etiology of the reversible enlargement of cerebrospinal fluid (CSF) spaces in anorexia nervosa, the changes resemble those in alcoholics. The mechanisms of brain changes in alcoholism, as shown experimentally, seem to us to throw light on the probable mechanism of reversible dystrophic brain changes in anorexia nervosa.

Neurobiology of anorexia and bulimia nervosa

“…Neuroimaging studies with CT reported cerebral atrophy and enlarged ventricles in ill AN (98)(99)(100)(101)(102)(103)(104)(105)(106). In BN similar but less pronounced structural brain abnormalities were reported (107) and may have been related to a chronic dietary restriction.…”

A case of marked cerebellar atrophy in a woman with anorexia nervosa and cerebral atrophy and a review of the literature

“…Possibly the most im- portant mechanism for undernutrition-induced brain changes could be hypercortisolism (Heinz, Martinez, & Haenggeli, 1977) and/or the decreased intravascular colloid pressure due to loss of serum protein, with subsequent movement of water into the CSF space (Artmann, Grau, Adelmann, & Schleiffer, 1985;Hoffmann et al, 1989a).…”

Altered 5-HT2A Receptor Binding after Recovery from Bulimia-Type Anorexia Nervosa: Relationships to Harm Avoidance and Drive for Thinness

“…While it is well known that ill AN subjects have reduced cortical volume (Ellison and Fong, 1998) and increased ventricular volume (Golden et al, 1996;Swayze et al, 1996;Katzman et al, 1996), it remains uncertain whether such brain volume reductions and enlargement of CSF spaces persist in the recovered state (Artmann et al, 1985;Swayze et al, 2003). Some studies showed that weightrecovered AN have significantly greater CSF volumes and smaller gray matter volumes than healthy control women Katzman et al, 1997, Krieg et al, 1988.…”