title: Loss of pons-to-hypothalamic white matter tracks in brainstem obesity.
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.
authors.affiliation: Department of Medicine and Center for the Study of Weight Regulation, Oregon Health & Science University, Portland, OR, USA.
authors.forename: J Q
authors.initials: JQ
authors.lastname: Purnell
authors.affiliation: Department of Neurology, Oregon Health & Science University, Portland, OR, USA.
authors.forename: D L
authors.initials: DL
authors.lastname: Lahna
authors.affiliation: Department of Medicine and Center for the Study of Weight Regulation, Oregon Health & Science University, Portland, OR, USA.
authors.forename: M H
authors.initials: MH
authors.lastname: Samuels
authors.affiliation: 1] The Advanced Imaging Research Center, Oregon Health & Science University, Portland, OR, USA [2] Department of Behavioral Neuroscience, Oregon Health & Science University, Portland, OR, USA.
authors.forename: W D
authors.initials: WD
authors.lastname: Rooney
authors.affiliation: 1] Department of Neurology, Oregon Health & Science University, Portland, OR, USA [2] Department of Behavioral Neuroscience, Oregon Health & Science University, Portland, OR, USA [3] Mental Health and Clinical Neurosciences Division, Veterans Affairs Medical Center, Oregon Health & Science University, Portland, OR, USA.
authors.forename: W F
authors.initials: WF
authors.lastname: Hoffman
mesh_terms: D000328:Adult; D001835:Body Weight; D001933:Brain Stem / Q000473:pathology; D003399:Craniotomy / Q000009:adverse effects* / Q000379:methods; D056324:Diffusion Tensor Imaging; D004322:Drainage / Q000379:methods*; D004435:Eating; D005247:Feeding Behavior; D001068:Feeding and Eating Disorders / Q000209:etiology* / Q000503:physiopathology / Q000601:surgery; D005260:Female; D015390:Gastric Bypass; D020786:Hemangioma, Cavernous, Central Nervous System / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D006963:Hyperphagia / Q000503:physiopathology; D007031:Hypothalamus / Q000473:pathology; D020300:Intracranial Hemorrhages / Q000601:surgery; D009434:Neural Pathways; D009765:Obesity / Q000209:etiology* / Q000503:physiopathology / Q000601:surgery; D011149:Pons / Q000473:pathology; D016896:Treatment Outcome; D015430:Weight Gain; D066127:White Matter / Q000293:injuries* / Q000473:pathology
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