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Loss of pons-to-hypothalamic white matter tracks in brainstem obesity

International Journal of Obesity volume 38, pages 1573–1577 (2014)Cite this article

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Abstract

Hyperphagia and obesity have been reported following damage to the hypothalamus in humans. Other brain sites are also postulated to be involved in the control of food intake and body weight regulation, such as the amygdala and brainstem. The brainstem, however, is thought to primarily integrate short-term meal-related signals but not affect long-term alterations in body weight, which is controlled by higher centers. The objective of this study was to identify structural pathways damaged in a patient with a brainstem cavernoma who experienced sudden onset of hyperphagia and >50 kg weight gain in <1 year following surgical drainage via a midline suboccipital craniotomy. Diffusion tensor imaging revealed loss of nerve fiber connections between her brainstem, hypothalamus and higher brain centers with preservation of motor tracks. Imaging and endocrine testing confirmed normal hypothalamic structure and function. Gastric bypass surgery restored normal appetite and body weight to baseline. This is the first report of ‘brainstem obesity’ and adds to the brain regions that can determine the long-term body weight set point in humans.

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Acknowledgements

We would like to acknowledge the assistance of Drs Madhavi Gaddam and Diana Negreanu with the endocrine workup during their fellowship training period. This work was supported in part by pilot funds through the OHSU Advanced Imaging Research Center and NIH grants R21 DK073729 and R56 DK 88207 (JQP).

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Authors and Affiliations

  1. Department of Medicine and Center for the Study of Weight Regulation, Oregon Health & Science University, Portland, OR, USA,

    J Q Purnell & M H Samuels

  2. Department of Neurology, Oregon Health & Science University, Portland, OR, USA,

    D L Lahna & W F Hoffman

  3. The Advanced Imaging Research Center, Oregon Health & Science University, Portland, OR, USA,

    W D Rooney

  4. Department of Behavioral Neuroscience, Oregon Health & Science University, Portland, OR, USA,

    W D Rooney & W F Hoffman

  5. Mental Health and Clinical Neurosciences Division, Veterans Affairs Medical Center, Oregon Health & Science University, Portland, OR, USA,

    W F Hoffman

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  1. J Q Purnell
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Correspondence to J Q Purnell.

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Purnell, J., Lahna, D., Samuels, M. et al. Loss of pons-to-hypothalamic white matter tracks in brainstem obesity. Int J Obes 38, 1573–1577 (2014). https://doi.org/10.1038/ijo.2014.57

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