Skip to main content
SpringerLink
Log in

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

  • Originals
  • Published:
Neuroradiology Aims and scope Submit manuscript

Summary

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Gagel O (1953) Die Erkrankungen des vegetativen Systems. In: Handbuch der Inneren Medizin, Bd.V, Teil 1, 4. Aufl. Springer, Berlin Göttingen Heidelberg

    Google Scholar 

  2. Martin F (1958) Pathologies des aspects neurologiques et psychiatriques de quelques manifestations carentielles avec troubles digestifs et neuro-endocriniens. Acta Neurol Belg 58: 816–830

    Google Scholar 

  3. Thomä H (1961) Anorexia nervosa. Huber-Klett, Bern Stuttgart

    Google Scholar 

  4. Geisler E (1953) Zur Problematik der Pubertätsmagersucht. Psychiatr Neurol Med Psychol 5:227–233

    Google Scholar 

  5. Heidrich R, Schmidt-Matthias H (1961) Encephalographische Befunde bei Anorexia nervosa. Arch Psychiatr Nervenkr 202: 183–201

    Google Scholar 

  6. Enzmann DR, Lane B (1977) Cranial computed tomography findings in anorexia nervosa. J Comput Assist Tomogr 1: 410–414

    Google Scholar 

  7. Heinz ER, Martinez J, Haenggeli A (1977) Reversibility of cerebral atrophy in Anorexia nervosa and Cushing's syndrome. J Comput Assist Tomogr 1:415–418

    Google Scholar 

  8. Cala LA, Mastaglia FL (1980) Computerized axial tomography in the detection of brain damage. Med J Aust 67:193–198

    Google Scholar 

  9. Nussbaum M, Shenker IR, Klein M (1980) Cerebral atrophy in anorexia nervosa. J Pediatr 96:867–869

    Google Scholar 

  10. Sein P, Searson S, Nicol AR (1981) Anorexia nervosa and pseudoatrophy of the brain. Br J Psychiatr 139:257–258

    Google Scholar 

  11. Luton JP, Guilhaume B, Marre M, Fredy D, Bricaire H (1981) Les anomalies tomodensitométriques cérébrales dans l'anorexie nerveuse. Nouv Presse Med 10:1071–1072

    Google Scholar 

  12. Zeumer H, Hacke W, Hartwich P (1982) A quantitative approach to measuring the cerebrospinal fluid space with CT. Neuroradiology 22:193–197

    Google Scholar 

  13. Kohlmeyer K, Lehmkuhl G, Poustka F (1983) Computed tomography in patients with anorexia nervosa. AJNR 4:437–438

    Google Scholar 

  14. Hay CG, Leonard JC (1979) Anorexia nervosa in males. Lancet 2:574–575

    Google Scholar 

  15. Maaser R (1977) In: Bergmann R, Bergmann KE, Kollmann F, Maaser R, Hövels O (Hrsg) Wachstumsatlas. Papillon, Wiesbaden

    Google Scholar 

  16. Documenta Geigy (1977) Wissenschaftliche Tabellen. 7. Aufl., Geigy AG, Basel

    Google Scholar 

  17. Huckman MS, Fox JH, Topel J (1975) The validity of criteria for the evaluation of cerebral atrophy by computed tomography. Radiology 116:85–92

    Google Scholar 

  18. Meese W, Kluge W, Grumme T, Hopfenmüller W (1980) CT evaluation of the CSF spaces in healthy persons. Neuroradiology 19:131–136

    Google Scholar 

  19. Steinhausen HC (1979) Anorexia nervosa — eine aktuelle Literaturübersicht. Teil 1: Diagnostische Aspekte. Z Kinder-Jugendpsychiatr 7:149–160

    Google Scholar 

  20. Vigersky RA, Loriaux DL (1977) Anorexia nervosa as a model of hypothalamic dysfunction. In: Vigersky RA (eds) Anorexia nervosa. Raven Press, New York, pp 109–121

    Google Scholar 

  21. Pirke KM (1981) Endokrinologische Aspekte der Anorexia nervosa. In: Meermann R (Hrsg) Anorexia nervosa — Ursachen und Behandlung. Enke, Stuttgart, S 32–42

    Google Scholar 

  22. Artmann H, Hacker H, von Gall M (1984) Reversible hirnatrophische Veränderungen im Computertomogramm bei Alkoholismus und Anorexia nervosa. In: Lechner H, Ladurner G, Ott E (Hrsg) Diagnostik und Therapie zerebraler Abbauprozesse. Perimed, Erlangen, S 158–164

    Google Scholar 

  23. Hallervorden J, Meyer JE (1956) Cerebrale Kinderlähmung. (Früh erworbene körperliche und geistige Defektzustände.) In: Handbuch der speziellen pathologischen Anatomie und Histologie, Bd. 13, Teil 4. Springer, Berlin, S 194–282

    Google Scholar 

  24. Zülch KJ (1954) Betrachtungen über die Entstehung frühkindlicher Hirnschäden auf Grund der klinischen und morphologischen Befunde. Arch Kinderheilkd 149:3–27

    Google Scholar 

  25. Gastaut H, Vigouroux M, Trevisan C, Regis H (1957) Le syndrome “Hémiconvulsion-Hémiplégie-Epilepsie” (Syndrome H.H.E.) Rev Neurol (Paris) 97:37–52

    Google Scholar 

  26. Veith G, Spittler JF (1981) Früh erworbene Hemiparesen und chronische Epilepsie. Eine klinisch-pathologische Studie an 64 Fällen. Fortschr Neurol Psychiatr 49:77–87

    Google Scholar 

  27. Seyfeddinipur N (1978) Zur Frage der frühkindlichen Hirnschädigung bei Alkoholikern unter Berücksichtigung der Schädelübersichtsaufnahmen. Nervenarzt 49:543–547

    Google Scholar 

  28. Göllnitz G (1954) Zur Bedeutung der frühkindlichen Hirnschädigung für die Kinderpsychiatrie. VEB Thieme, Leipzig

    Google Scholar 

  29. Winkler WT (1958) Die Beziehung zwischen frühkindlicher Hirnschädigung und Neurosen im Kindes- und Jugendalter. Z Psychother Med Psychol 12:1–10

    Google Scholar 

  30. Müller-Küppers M (1969) Das leicht hirngeschädigte Kind. Hippocrates, Stuttgart

    Google Scholar 

  31. Lempp R (1970) Frühkindliche Hirnschädigung und Neurose. 2. Aufl. Huber, Bern Stuttgart

    Google Scholar 

  32. Klepel H, Koch RD (1975) Häufigkeit frühkindlicher Hirnschäden bei Kindern mit Verhaltensstörungen. Psychiatr Neurol Med Psychol 27:213–218

    Google Scholar 

  33. Dyke CG, Davidoff LM, Masson CB (1933) Cerebral hemiatrophy with homolateral hypertrophy of the skull and sinuses. Surg Gynec Obstet 57:588–600

    Google Scholar 

  34. Fischgold H, Metzger J (1951) Signes radiographiques discrets et précoses des atrophies cérébrales unilaterales. J Radiol Electrol 32:733–741

    Google Scholar 

  35. Mc Rae DL (1974) Radiology in epilepsy. In: Vinken PJ, Bruyn GW (eds) Handbook of clinical neurology, Vol. 15. North-Holland Publ. Comp, Amsterdam

    Google Scholar 

  36. Jacoby CG, Go RT, Hahn FJ (1977) Computed tomography in cerebral hemiatrophy. Am J Roentgenol 129:5–9

    Google Scholar 

  37. Grau H, von Gall M, Emrich R (1978) Analysis of cerebral defective states acquired in early life. Neuroradiology 16:71–73

    Google Scholar 

  38. Spatz H (1939) Pathologische Anatomie der Kreislaufstörungen des Gehirns. Z Ges Neurol Psychiatr 167:301–357

    Google Scholar 

  39. Noetzel H (1949) Über den Einfluß des Gehirns auf die Form der Nebenhöhlen des Schädels. Dtsch Z Nervenheilk 160:126

    Google Scholar 

  40. Meyer JE (1953) Über die Lokalisation frühkindlicher Hirnschäden in arteriellen Grenzgebieten. Arch Psychiatr Nervenkr 190:328–341

    Google Scholar 

  41. Lindenberg R (1955) Compression of brain arteries as pathogenetic factor for tissue necrosis and their areas of predilection. J Neuropathol Exp Neurol 14:223–243

    Google Scholar 

  42. Schiffer KH (1956) Zur Ableitung von Entwicklungsvorgängen aus dem Röntgenbild des Schädels. Acta Radiol (Stockh) 46:123–129

    Google Scholar 

  43. Dekaban AS, Norman RM (1958) Hemiplegia in early life associated with thrombosis of the sagittal sinus and its tributary veins in one hemisphere. J Neuropathol Exp Neurol 17: 461–470

    Google Scholar 

  44. Grau H, Hacker H (1979) The influence of early brain lesions on the development of the skull. Presented at the VIIIth Congress of the European Society of Neuroradiology. Strasbourg

  45. Grau H (1984) Extranigrale Hirnveränderungen beim Parkinson-Syndrom. Neuroradiologische Befunde. In: Fischer PA (Hrsg) Parkinson plus: Zerebrale Polypathie beim Parkinson-Syndrom. Springer, Berlin Heidelberg New York Tokyo, S 32–51

    Google Scholar 

  46. Courville CB (1960) Central hemorrhagic encephalopathy of early infancy. Report of three verified cases suggesting the genesis of infantile cystic degeneration in a paranatal anoxic disorder. Neurology (Minneap) 10:70–80

    Google Scholar 

  47. Banker BQ, Larroche JC (1962) Periventricular leukomalacia of infancy. Arch Neurol 7:386–410

    Google Scholar 

  48. DeReuck J, Chattha AS, Richardson EP (1972) Pathogenesis and evolution of periventricular leukomalacia in infancy. Arch Neurol 27:229–236

    Google Scholar 

  49. Gilles FH, Murphy SF (1969) Perinatal telencephalic leucoencephalopathy. J Neurol Neurosurg Psychiatr 32:404–413

    Google Scholar 

  50. Rorke LB (1982) Pathology of perinatal brain injury. Raven Press, New York

    Google Scholar 

  51. Schwartz P (1981) Birth injuries of the newborn: morphology, pathogenesis, clinical pathology and prevention. Hafner, New York

    Google Scholar 

  52. Kalbag RM, Wolf AL (1967) Cerebral venous thrombosis. Oxford University Press, New York

    Google Scholar 

  53. Towbin A (1970) Central nervous system damage in the human fetus and newborn infant. Am J Dis Child 119:529–542

    Google Scholar 

  54. Takashima S, Tanaka K (1978) Development of cerebrovascular architecture and its relationship to periventricular leukomalacia. Arch Neurol 35:11–16

    Google Scholar 

  55. Lou HC, Lassen NA, Friis-Hansen B (1979) Impaired autoregulation of cerebral blood flow in the decreased newborn. J Pediatr 94:118–121

    Google Scholar 

  56. Veith G (1960) Über die Pathogenese des perinatalen Hirnschadens. Geburtshilfe Frauenheilk 20:905–917

    Google Scholar 

  57. Larroche JC (1972) Subependymal pseudo-cysts in the newborn. Biol Neonate 21:170–183

    Google Scholar 

  58. Altegoer E (1952) Zur Morphologie und Genese des akuten Hirnödems bei ernährungsgestörten Säuglingen. Beitr Pathol Anat 112:205

    Google Scholar 

  59. Hallervorden J, Wilke G (1954) Über Hirnschäden bei dystrophischen Erkrankungen des Kleinkindes (Säuglingsintoxikation) und ihre Folgen. In: Proceedings of the first International Congress of Neuropathology, Rom 1952, 3:304–309

  60. Dublin AB, Dublin WB (1978) Cerebral pseudoatrophy and computed tomography: Two illustrative case reports. Surg Neurol 10:209–212

    Google Scholar 

  61. Faust C (1952) Hirnatrophie nach Hungerdystrophie. Nervenarzt 23:406–412

    Google Scholar 

  62. Petry F (1954) Zur Pathogenese der Hirnschädigung nach Mangel- und Fehlernährung. Medizinische Welt 20: 1675–1678

    Google Scholar 

  63. Schulte W, Stiawa R (1958) Organische Hirnschädigungen nach schwerer Hungerdystrophie. Fortschr Neurol Psychiatr 26:66–82

    Google Scholar 

  64. Wilke G (1961) Akute cerebrale Hungerschäden in Kriegsgefangenschaft und ihre neurologischen und psychiatrischen Folgen. In: Gruhle HW, Jung R, Mayer-Gross W, Müller M (Hrsg) Psychiatrie der Gegenwart. Forschung und Praxis, Bd. III. Springer, Berlin Göttingen Heidelberg

    Google Scholar 

  65. Bentson J, Reza M, Winter J, Wilson G (1978) Steroids and apparent cerebral atrophy on computed tomography scans. J Comput Assist Tomogr 2:16–23

    Google Scholar 

  66. Lagenstein J, Willig RP, Kühne D (1979) Cranial computed tomography (CCT) findings in children treated with ACTH and Dexamethasone: first results. Neuropädiatrie 10:370–384

    Google Scholar 

  67. Okuno T, Ito M, Konishi Y, Yoshioka M, Nakano Y (1980) Cerebral atrophy following ACTH therapy. J Comput Assist Tomogr 4:20–23

    Google Scholar 

  68. Carlen PL, Wortzman G, Holgate RC, Wilkinson DA, Rankin JG (1978) Reversible cerebral atrophy in recently abstinent chronic alcoholics measured by computed tomography scans. Science 200:1076–1078

    Google Scholar 

  69. Ron MA, Acker W, Lishman WA (1980) Morphological abnormalities in the brains of chronic alcoholics. A clinical, psychological and computerized axial tomographic study. Acta Psychiatr Scand [Suppl] 286:41–46

    Google Scholar 

  70. Sarabia F, Bowden C (1980) Computerized tomographic evidence of cerebral atrophy in heavy drinkers. South Med J 73: 716–718

    Google Scholar 

  71. Carlen PL, Wilkinson DA (1980) Alcoholic brain damage and reversible deficits. Acta Psychiatr Scand [Suppl] 286:103–118

    Google Scholar 

  72. Artmann H, von Gall M, Hacker H, Herrlich J (1981) Reversible enlargement of cerebral spinal fluid spaces in chronic alcoholics. AJNR 2:23–27

    Google Scholar 

  73. Neumann NU (1981) Sind hirnatrophische Prozesse bei chronischen Alkoholikern reversibel? Psycho 7:237–242

    Google Scholar 

  74. Noble EP, Tewari S (1973) Protein and ribonucleic acid metabolism in brain of mice following chronic alcohol consumption. Ann NY Acad Sci 215:333–345

    Google Scholar 

  75. Rawat AK (1975) Ribosomal protein synthesis in fetal and neonatal rat brain as influenced by maternal ethanol consumption. Res Commun Chem Pathol 12:723–732

    Google Scholar 

  76. Riley JN, Walker DW (1978) Morphological alterations in hippocampus after long-term alcohol consumption in mice. Science 201:646–648

    Google Scholar 

  77. Volk B, Berlet HH, Maletz J (1980) The influence of alcohol on cerebellar histo- and synaptogenesis. Light and electron microscopic, histochemical and neurochemical investigations of the rat cerebellar cortex. Drug Alcohol Depend 6:67–68

    Google Scholar 

  78. Volk B, Maletz J, Tiedemann M, Mall G, Klein C, Berlet HH (1981) Impaired maturation of Purkinje cells in the fetal alcohol syndrome of the rat. Light and electron microscopic investigations. Acta Neuropathol 54:19–29

    Google Scholar 

  79. Dyson SE, Jones DG (1976) Somme effect of undernutrition on synaptic development — a quantitative ultrastructural study. Brain Res 114:365–378

    Google Scholar 

  80. Nicholson JL, Altman J (1972) Synaptogenesis in the rat cerebellum: Effects of early hypo- and hyperthyroidism. Science 176:530–532

    Google Scholar 

  81. Barnes DE, Walker DW (1979) Morphological alterations of hippocampus and cerebellum resulting from prolonged ethanol consumption in rats. Alcoholism (New York) 3:168

    Google Scholar 

  82. VanderLaan WP, Parker DC, Rossman LG, VanderLaan EF (1970) Implications of growth hormone release in sleep. Metabolism 19:891–897

    Google Scholar 

  83. Casper RC, Davis JM, Pandey GN (1977) The effect of the nutritional status and weight changes on hypothalamic function test in anorexia nervosa. In: Vigersky RA (ed) Anorexia nervosa. Raven Press, New York, pp 137–148

    Google Scholar 

  84. Sherman BM, Halmi KA (1977) Effect of nutritional rehabilitation on hypothalamic-pituitary function in norexia nervosa. In: Vigersky RA (ed) Anorexia nervosa. Raven Press, New York, pp 221–224

    Google Scholar 

  85. Gross HA, Lake CR, Ebert MH, Ziegler MG, Kopin IJ (1979) Catecholamine metabolism in primary anorexia nervosa. J Clin Endocrin Metabol 49:805–809

    Google Scholar 

  86. Crisp AH, Fenton G, Scotten L (1968) A controlled study of the EEG in anorexia nervosa. Br J Psychiatry 114:1149–1160

    Google Scholar 

  87. Schenck K, Remschmidt H (1974) EEG-Befunde bei Anorexia nervosa. Z Kinder-Jugendpsychiatr 2:200–210

    Google Scholar 

  88. Bergmann H, Borg S, Hindmarsh T, Ideström CM, Mützell S (1980) Computed tomography of the brain and neuropsychological assessment of alcoholic patients. Adv Exp Med Biol 126:771–786

    Google Scholar 

  89. Swiercinsky DP, Leigh G (1979) Comparison of neuropsychological data in the diagnosis of brain impairment with computerized tomography and other neurological procedures. J Clin Psychol 35:243–246

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Radiology, Section of Neuroradiology University Clinics, Johann-Wolfgang-Goethe-University, Frankfurt/Main, FRG

    H. Artmann, H. Grau & M. Adelmann

  2. Department of Psychiatry, Section of Child- and Youth-Psychiatry, University Clinics, Johann-Wolfgang-Goethe-University, Frankfurt/Main, FRG

    R. Schleiffer

Authors
  1. H. Artmann
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. H. Grau
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. M. Adelmann
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. R. Schleiffer
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

Artmann, H., Grau, H., Adelmann, M. et al. Reversible and non-reversible enlargement of cerebrospinal fluid spaces in anorexia nervosa. Neuroradiology 27, 304–312 (1985). https://doi.org/10.1007/BF00339562

Download citation

  • Received:

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF00339562

Key words

Search

Navigation