scholarly journals Cerebellar Tonsillar Herniation in Sudden Death of An Adolescent Anorexia Nervosa Patient: A Case Report.

2021 ◽  
Author(s):  
Tasuku Kitajima ◽  
Ryoko Otani ◽  
Naho Matsushima ◽  
Naoki Matsubara ◽  
Takeshi Inoue ◽  
...  
Keyword(s):  
Anorexia Nervosa ◽  
Sudden Death ◽  
Cardiopulmonary Arrest ◽  
Autism Spectrum ◽  
Severe Malnutrition ◽  
Tonsillar Herniation ◽  
Autopsy Imaging ◽  
Case Presentation ◽  
Cerebellar Tonsillar Herniation ◽  
Unexpected Findings

Abstract Background: Anorexia nervosa not only results in severe malnutrition but also carries a high risk of sudden death. Although fatal arrhythmias are the most common cause of sudden death, it is often unclear what exactly causes them. To the best of our knowledge, there have been no reports of cerebral herniations in patients with anorexia nervosa.Case presentation: A 17-year-old adolescent girl with neuropathy and autism spectrum disorder was admitted to the pediatric ward for extreme weight loss. Eight hours after admission, she suddenly went into cardiopulmonary arrest and died despite resuscitation. A postmortem autopsy revealed the unexpected findings of generalized severe cerebral edema and cerebellar tonsillar herniation.Conclusion: Intracranial hypertension may need to be considered when the condition of patients with anorexia nervosa suddenly worsens during refeeding periods. Postmortem autopsy and autopsy imaging are recommended to determine the exact cause of sudden death.

scholarly journals Severe Starvation-Induced Hepatocyte Autophagy as a Cause of Acute Liver Injury in Anorexia Nervosa: A Case Report

2013 ◽  
Vol 2013 ◽  
pp. 1-4 ◽  
Author(s):  
S. Restellini ◽  
L. Spahr ◽  
L. Rubbia Brandt
Keyword(s):  
Anorexia Nervosa ◽  
Liver Injury ◽  
Acute Liver Injury ◽  
Clinical Situation ◽  
Severe Malnutrition ◽  
Hepatic Glycogen ◽  
Glycogen Depletion ◽  
Case Presentation ◽  
Common Causes ◽  
Liver Tests

Introduction. Mild elevation of transaminase may be observed in anorexia nervosa, but acute liver injury is uncommon. A complex programmed cell death in response to starvation, called autophagy, has been described in experimental and human studies.Case Presentation. A 24-year-old woman suffering from anorexia nervosa was hospitalized for severe malnutrition. At admission, there were biological signs of acute liver injury but no electrolytic imbalance. After having ruled out the most common causes of liver injury, the patient was carefully refed. As liver tests remained abnormal, liver biopsy was performed. At histology and electron microscopy, numerous signs suggestive of starvation-induced hepatocyte autophagy were found.Discussion. Severe starvation can be associated with acute liver injury that is slowly reversible with careful enteral nutrition. In this clinical situation, profound hepatic glycogen depletion in association with autophagy appears as the leading cause of liver injury.

scholarly journals Prevalence of autism spectrum disorder and autistic traits in children with anorexia nervosa and avoidant/restrictive food intake disorder

2021 ◽  
Vol 15 (1) ◽  
Author(s):  
Takeshi Inoue ◽  
Ryoko Otani ◽  
Toshiyuki Iguchi ◽  
Ryuta Ishii ◽  
Soh Uchida ◽  
...  
Keyword(s):  
Autism Spectrum Disorder ◽  
Anorexia Nervosa ◽  
Food Intake ◽  
Autistic Traits ◽  
Autism Spectrum ◽  
Eating Attitudes ◽  
Spectrum Disorder ◽  
Autism Spectrum Quotient ◽  
Multicenter Cohort Study ◽  
Feeding And Eating Disorders

Abstract Background Autism spectrum disorder (ASD) and feeding and eating disorders (FEDs) such as anorexia nervosa (AN) are strongly linked as evidenced by frequent comorbidity and overlapping traits. However, eating and social behaviors are shaped by culture, so it is critical to examine these associations in different populations. Moreover, FEDs are heterogeneous, and there has been no examination of autistic traits in avoidant/restrictive food intake disorder (ARFID). Methods Therefore, we investigated the prevalence of ASD and autistic traits among Japanese children with AN (n = 92) or ARFID (n = 32) from a prospective multicenter cohort study using the Autism Spectrum Quotient Children’s version (AQC) and Children’s Eating Attitudes Test (ChEAT26). Results ASD prevalence was high in both AN and ARFID (16.3 and 12.5%, respectively). The AN group exhibited significantly higher scores on all AQC subscales than an age-matched healthy control (HC) group, but there were no significant correlations between AQC scores and ChEAT26 scores. In the AFRID group, AQC scores did not differ from HCs, but significant correlations were found between total AQC and ChEAT26 scores and between several AQC and ChEAT26 subscales. Conclusions Both the AN and ARFID groups had high prevalence rates of ASD. The AN group showed a significantly higher degree of autistic traits than the HC group; however, no difference was found between the ARFID and HC groups. Clinicians need to be aware of these rates when working with children with ED.

Complete posterior cranial vault distraction osteogenesis to correct Chiari malformation type I associated with craniosynostosis

2021 ◽  
pp. 1-7
Keyword(s):  
Foramen Magnum ◽  
Posterior Cranial Fossa ◽  
Type I ◽  
Intracranial Volume ◽  
Tonsillar Herniation ◽  
Chiari Malformation Type I ◽  
Cerebellar Tonsillar Herniation ◽  
Cranial Fossa ◽  
The Mean ◽  
Tonsillar Descent

OBJECTIVE Posterior vault distraction osteogenesis (PVDO) is an effective tool to increase intracranial volume and expand the posterior cranial fossa. During PVDO, the authors extended osteotomy posterior to the foramen magnum to fully expand the posterior cranial fossa. The aim of this study was to investigate the efficacy of complete PVDO in posterior fossa expansion and treatment of Chiari malformation type I (CM-I) in patients with craniosynostosis. METHODS Patients with craniosynostosis who had undergone complete PVDO between January 2012 and May 2020 were reviewed retrospectively. A coronal osteotomy extending to the foramen magnum was performed and the foramen magnum was decompressed by removing its posterior rim with a 1-mm Kerrison rongeur. Four distractor devices were placed and the vector of distraction was controlled from the posterior to the inferior-posterior direction, depending on the deformity. Changes in the intracranial volume, posterior cranial fossa area, and cerebellar tonsillar descent were measured after complete PVDO by using CT and MRI. RESULTS A total of 11 patients with craniosynostosis and concurrent CM-I were included in the study. The mean age was 34.6 ± 24.0 months (continuous variables are expressed as the mean ± SD throughout). One patient had sleep apnea, which was consistent with CM-I, and another patient had a headache, which was nonspecific. The intracranial volume increased from 1179.6 ± 180.2 cm3 to 1440.6 ± 251.5 cm3 (p = 0.003; 24.5% increase compared to the preoperative volume). The posterior skull base area increased from 44.9 ± 19.3 cm2 to 72.7 ± 18.1 cm2 (p = 0.004). Cerebellar tonsillar descent decreased in all 11 patients after complete PVDO (preoperative: 10.8 ± 3.7 mm, postoperative: 2.7 ± 3.0 mm; p = 0.003). Among the 11 patients, 5 showed complete resolution of cerebellar tonsillar herniation. CONCLUSIONS Complete PVDO can more efficiently expand the posterior cranial fossa, unlike conventional methods. Moreover, it helps to relieve cerebellar tonsillar herniation. Complete PVDO is a powerful tool to increase the intracranial and posterior fossa volumes in patients with craniosynostosis and concurrent CM-I.

Anorexia nervosa and the risk of sudden death

2002 ◽  
Vol 112 (4) ◽  
pp. 327-328 ◽  
Author(s):  
Alfredo Vannacci ◽  
Roberto Baronti ◽  
Emanuela Masini ◽  
Claudia Ravaldi ◽  
Valdo Ricca
Keyword(s):  
Anorexia Nervosa ◽  
Sudden Death

scholarly journals Pneumococcal sepsis associated with adrenal apoplexy in a young woman with anorexia nervosa

2013 ◽  
pp. 25-29
Author(s):  
Nicola Maria Vitola ◽  
Dante Lo Pardo ◽  
Romualdo Cirillo ◽  
Matteo De Roberto ◽  
Pier Giovanni Crocco ◽  
...  
Keyword(s):  
Body Mass Index ◽  
Emergency Department ◽  
Anorexia Nervosa ◽  
Sudden Death ◽  
Clinical Picture ◽  
Causes Of Death ◽  
Critical Conditions ◽  
Crude Rate ◽  
Treatment Practices ◽  
Pneumococcal Sepsis

BACKGROUND A crude rate of mortality of 5% has been quoted for anorexia nervosa in recent studies. Nowadays the mechanism of death is unclear and various authors recommend that any anorexia nervosa death be reported and that, where possible, an autopsy be performed. METHODS In this work we present a case of sudden death in anorexia nervosa with unexpected autopsy findings. A 21-years-old woman with long-standing anorexia nervosa, severely underweight with a body mass index of 14.47 kg/m2, has been taken to the Emergency Department in very critical conditions. Despite the attempts of resuscitation, she died shortly afterwards. Therefore an autopsy has been requested in order to clarify the causes of death. RESULTS The clinical picture, laboratory parameters, histology and microbiological investigations were consistent with pneumococcal sepsis associated adrenal apoplexy. CONCLUSIONS The cause of death in anorexia nervosa cannot reliably be established from antemortem clinical features. All anorexia nervosa deaths should be reported together with description of necropsy. This may lead to advances in the knowledge and treatment practices.

scholarly journals Anorexia Nervosa and Autism Spectrum Disorders: Future Hopes Linked to Mucosal Immunity

2019 ◽  
Vol 26 (6) ◽  
pp. 265-275
Author(s):  
Tristan Gabriel ◽  
Stéphane Paul ◽  
Anne Berger ◽  
Catherine Massoubre
Keyword(s):  
Anorexia Nervosa ◽  
Autism Spectrum Disorders ◽  
Mucosal Immunity ◽  
Autism Spectrum ◽  
Spectrum Disorders

scholarly journals Non-contrast computed tomography of type A acute aortic dissection in patients with out-of-hospital cardiopulmonary arrest: a case series

2019 ◽  
Vol 3 (4) ◽  
pp. 1-5 ◽  
Author(s):  
Shinsuke Takeuchi ◽  
Yoshihiro Yamaguchi ◽  
Hideaki Yoshino
Keyword(s):  
Computed Tomography ◽  
Aortic Dissection ◽  
Causes Of Death ◽  
Acute Aortic Dissection ◽  
Cardiopulmonary Arrest ◽  
Case Series ◽  
Type A ◽  
Autopsy Imaging ◽  
Conventional Autopsy ◽  
Contrast Ct

Abstract Background The prognosis of patients admitted for acute aortic dissection (AAD) has remarkably improved. However, we must also consider out-of-hospital cardiopulmonary arrest (OHCPA) patients while assessing the prognosis. In recent years, autopsy imaging has become more common as an alternative to conventional autopsy. Therefore, we reviewed our OHCPA patients with type A AAD using acute phase non-contrast computed tomography (CT). Case summary Here, we report a case series of three patients who developed OHCPA and were diagnosed with type A AAD using non-contrast CT. Although the direct causes of death varied in each case, we could easily determine the direct causes of death from clinical course of the condition and from non-contrast CT. Discussion Although non-contrast CT does not completely replace autopsy, if its convenience and non-invasiveness make it possible for more patients to undergo the procedure, the real prognosis (including morbidity and mortality) may be better understood. Therefore, we considered it significant to use non-contrast CT for investigating the cause of sudden death.

Diagnostic Issues in Primary Anorexia Nervosa

1982 ◽  
Vol 11 (3) ◽  
pp. 235-244 ◽  
Author(s):  
Larry Kirstein
Keyword(s):  
Weight Loss ◽  
Body Image ◽  
Anorexia Nervosa ◽  
Literature Review ◽  
Clinical Case ◽  
Eating Patterns ◽  
Case Presentation ◽  
Body Image Disturbances

A literature review and clinical case presentation approach are employed to highlight unresolved diagnostic issues in Primary Anorexia Nervosa. The material is examined and discussed along a multidimensional list of variables considered important for the diagnosis, including definitions of weight loss, associated biological symptoms, eating patterns and body image disturbances.

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