Eating Disorder after Head Injury

Abstract

A 19-year old Japanese man had shown episodes of binge eating and vomiting after two times of accident in Judo. At his 17 years of age, he had the first sport accidnent by Judo and sustained cerebral concussion. He had high fever above 39℃ and appetite loss. He had lost 10 kg during the 1 month after that episode. He spent several weeks in the hospital. Brain computor tomography (CT) and EEG showed the normal findings. However, his cerebral spinal fluid (CSF) was xanthochoromic. When he was discharged with no neurological deficits, xanthochromia in CSF was improved. One year after the first accident, he had the second sport accident. His CSF was also xanthochromic and its pressure was elevated. After the second accident, he showed some change in his emotion and personality. Three months later, when there was a trouble between his father and sister, he started his binge eating accompanied with vomiting. One year later, he got into heavy drinking and gradually developed generlized edema. When admitted to our hospital in June, 1985,he weighed 46.8 kg (ideal body weight : 57.4 kg). Laboratory examinations demonstrated hypoproteinemia and hypogammaglobulinemia with ECG abnormality, sinus bradycardia. Brain CT demonstrated mild cerebral atrophy. He had showed the low T_3 syndroem by endocrinological examinations. Cortisol circadian rhythm and dexamethasone suppression test were normal. However, TSH response to thyrotropin-releasing hormone (TRH) and GH response to insulin tolerance test (ITT) were depayed and no response, respectively. Compulsory feeding using the elementary diet, behavior control, personal psychotherapy, and family therapy were conducted . Thereafter, he became able to resume his social life.In the literature, only 5 cases with eating disorder associated with trauma including this patient (2 men and 3 women; mean age 21.8 yr.) were reported. Four of them suffered from traffic accidents and the remaining one from a sport accident. Mean per cent of ideal body weight at admission was 75% ranging from 64% to 82%. Most of the patients had mental and characteristic changes after trauma as well as changes in eating habit. Namely, the dysorexia nervosa type (bulimics and vomiting) was found in 4 of 5 these patients. However, the anorexia nervosa type (restricting) was seen in only the remainign one patient.It is considered that the minimum brain damage in hypothalamus and the change in personality caused by the accident might be correlated with eating disorder.