Right hemispheric frontal lesions as a cause for anorexia nervosa report of three cases

Object: Aetiology and pathogenesis of eating disorders is a matter of controversy. In some cases they can occur in association with tumours involving the temporal cortex, in temporal lobe epilepsy or in the advanced state of degenerative diseases involving temporal structures. We report about three patients with right frontal intracerebral lesions, one oligo-astrocytoma and two vascular malformations, associated with partial seizures and anorexia nervosa. Patients and Methods: 3 patients, one female and two men with anorexia nervosa and right frontal intracerebral lesions were admitted to our wards due to focal seizures or loss of consciousness. They were treated either microsurgically or by endovascular embolization after neuro-imaging. In our retrospective analysis of the patients' reports and course we investigated the histopathology of the lesions, duration of the eating disorder and the clinical outcome. Results: Two patients underwent craniotomy with extirpation of the lesion. In one case histology revealed an oligo-astrocytoma, in the other haemorrhagic infarction due to a venous malformation. The patient with the arteriovenous malformation (AVM) was embolized with microparticles. The patients with the oligoastrocytoma and AVM totally recovered. They gained weight and stayed seizure free. The patient with the infarction remained in a vegetative state. Conclusions: Right frontal intracerebral lesions with their close relationship to the limbic system could be causative for eating disorders. We therefore recommend performing a cranial MRI in all patients with suspected eating disorders, especially if they occur in combination with focal seizures.