Abstract
A 23-year-old woman was carried to our hospital as an emergency case by ambulance because of loss of consciousness at home. She had been suffering from anorexia nervosa since 1989,when she was 20 years old. She had admitted in other hospitals 8 times prior to this admission. She referred to the intensive care unit because she was in a state of coma and needed to control her respiration by respirator. Physical examination showed as follows ; blood pressure 110/76 mmHg. body temp. 33. 8℃, pulse rate 55/min, body height 153 cm, body weight 24. 1 kg. Neurological findings revealed that brain stem response was stable and focal signs were not detected. Laboratory data revealed severe hypoglycemia (blood sugar was 20 mg/dl), severe liver dysfunction and normal oxygen saturation of arterial blood. We diagnosed her as anorexia nervosa accompanied with hypoglycemic coma. In spite of intravenous injection of glucose, her consciousness level did not resume. Furthermore she had status epilepticus with tonic seizure. Her electric encephalogram on the second day showed slowing of the background activity and that on the fourth day accurately showed periodic synchronous discharges (hereafter PSD) . She showed responses to phenytoin so that PSD was disappeared and her consciousness level was rapidly repaired. Then she markedly regressed and rejected our therapy. So we received her supportively and recommended her father to participate in our therapy positively. Then she could take 1600 kcal diet without resistance and gained in weight while her father took care of her. Though she couldn't change her slender idea, she became able to establish a good relationship with us and leave hospital. Hypoglycemic coma and/or epileptic seizures in cases of anorexia nervosa are rare events. Furthermore PSD has never been reported. We guess our case fell into severe brain damage due to hypoglycemic encephalopathy because appearance of PSD is indispensable to diffuse damage of brain cortex. We found it later that the therapeutic course of this case was successful because insulin shock therapy was combined with reparenting therapy. Her father's acceptance of her regression brought back her psychic stability and basic trust between them.
