Abstract
A case report was made concerning a 21-year-old male patient who had shown episodes of excessive binge-eating associated with habituated vomiting. He had been entirely well until February, 1973,when he suffered a traffic accident in which he was hit severely on the head and remained unconscious for about half an hour. About 9 months after the head injury the patient began to show frequent, episodes of gorging and vomiting, gradually losing weight in the process. When admitted to our hospital in June, 1974,he weighed 43 kg (ideal bodyweight : 64 kg). It was confirmed that his maximal caloric intake amounted to as much as 14,000 Kcal per day during the ad lib. diet for the first week after hospitalization. Laboratory examinations demonstrated markedly low potassemia along with ECG abnormalities such as T wave flattening, sinusbradycardia and shortend QTc time, which were understood as a manifestation of heavy vomiting. Endocrine examinations revealed such abnormalities as low BMR, delayed pattern of glucose tolerance curve, higher basal level of serum GH and its delayded response to both arginine and L-DOPA. However, he was euthyroid and showed normal basal levels of serum FSH, LH and testosterone, although the 24-hour urinary hypophyseal gonadotropin excretion was slightly decreased. No space occupying lesion in the brain was observed by CAG and CT-scanning, but the following EEG findings were obtained : for about 2 months during the posttraumatic period, the patient indicated alpha wave slowing with sporadic theta-burst (symmetrical); this was followed by nearly the same patterns during the emaciated period. These abnormalities improved gradually after restoration of normal body weight. In addition to abnormal eating behavior, changes in emotion and personality to a certain extent were also found after the head trauma. These findings suggest that the head trauma presumably acted as an initiating factor in some functional disorder in the vicinity of the satiety center and/or amygdala. The patient was able to entirely resume his social life again about 5 years later, mainly through behavior modification with operant-conditioning and self-control. Although the etiological problems of dysorexia nervosa are still controversial, this rare case seems to contribute toward discussion of the pathogenesis of the disease from the view point of primary hypothalamic disturbance in the sense of minor brain damage.
