ABSTRACT
OBJECTIVE: Converging evidence suggests a role for the anterior cingulate cortex (ACC) in the pathophysiology of anorexia nervosa (AN). This study sought to determine whether ACC volume was affected by starvation in active AN and, if so, whether this had any clinical significance. METHOD: Eighteen patients with active AN and age- and gender-matched normal controls underwent magnetic resonance imaging (MRI). Sixteen patients (89%) with AN had intelligence quotients (IQ) testing at intake, 14 (78%) had repeat MRIs after weight normalization, and 10 (56%) had outcome data at 1-year posthospitalization. RESULTS: Right dorsal ACC volume was significantly reduced in active AN patients versus controls and was correlated with lower performance IQ. While ACC normalization occurred with weight restoration, smaller change in right dorsal ACC volume prospectively predicted relapse after treatment. CONCLUSION: Reduced right dorsal ACC volume during active AN relates to deficits in perceptual organization and conceptual reasoning. The degree of right dorsal ACC normalization during treatment is related to outcome.
Subject(s)
Anorexia Nervosa/physiopathology , Gyrus Cinguli/pathology , Starvation/physiopathology , Adolescent , Adult , Anorexia Nervosa/rehabilitation , Atrophy , Case-Control Studies , Cognition , Female , Follow-Up Studies , Humans , Intelligence , Magnetic Resonance Imaging , Male , Matched-Pair Analysis , Weight GainABSTRACT
OBJECTIVE: To examine whether gray and white matter volumes are preferentially reduced and cerebral spinal fluid (CSF) increased with starvation in patients with anorexia nervosa compared with healthy controls and to determine what changes occur with weight normalization. METHOD: Whole intracranial volumes of patients and controls were segmented into gray matter, white matter, and CSF volumes and results compared. A subgroup of patients were rescanned after weight normalization. RESULTS: Total white matter and several regional white matter volumes were significantly reduced and total and regional CSF volumes were significantly increased in patients versus controls whereas gray matter was not significantly reduced. Total and regional CSF volumes were significantly decreased in patients upon weight normalization whereas white and gray matter volumes increased. DISCUSSION: These changes in brain tissue may be related to a variety of pathophysiologic mechanisms. We hypothesize that insulin-like growth factor-1 may be involved.
Subject(s)
Anorexia Nervosa/cerebrospinal fluid , Anorexia Nervosa/therapy , Brain/metabolism , Cerebrospinal Fluid/metabolism , Adult , Anorexia Nervosa/pathology , Body Mass Index , Brain/pathology , Convalescence , Female , Follow-Up Studies , Humans , Insulin-Like Growth Factor I/metabolism , Magnetic Resonance Imaging , Male , Time FactorsABSTRACT
This case series reports results of single photon emission computed tomography (SPECT) studies in three patients with fetal alcohol syndrome (FAS), who had previously undergone structural magnetic resonance imaging (MR). The MR studies revealed several brain anomalies, including microcephaly, agenesis or hypoplasia of corpus callosum and agenesis of hippocampal commissure. The SPECT data revealed that the CBF was reduced by at least 25% in the temporal region relative to the cerebellum in all three patients. By contrast, the temporal-cerebellar differences were between 4% and 7% in two controls. The functional abnormalities in FAS, like neuroanatomical abnormalities, are likely to be multiple and varied because of heterogeneity of this syndrome. Our findings suggest the need for a larger study to test the hypothesis that temporal lobe abnormalities are a notable occurrence in FAS. Discovery of specific regional brain dysfunctions (such as temporal lobe dysfunction) that are particularly vulnerable to alcohol's teratogenic effect may allow clinicians and researchers to look for markers useful in FAS screening and may have implications for prevention and treatment of FAS.
