Anorexia nervosa and sudden death in childhood: clinical data and results obtained from quantitative neurohistological investigations of cortical neurons.

A crude rate of mortality of 5.9% has been quoted for Anorexia nervosa (AN) in recent studies. There are different causes of death ranging from suicide to sudden death. Autopsy data are extremely rare about brain alterations in deceased AN patients. Reported in this study is a female patient, aged 13.5 years, who died of acute AN. Quantitative neurohistological investigation post mortem was performed on her brain. Results were compared with data obtained from a girl of the same age with no contributory neuropsychiatric findings. In the cortex of the anorexia case beside typical pyramidal neurons, a slim neuron type with one extremely long basal dendritic field was found to occur more frequently than normal. In the neurons of the AN case, the ramification pattern of single basal dendritic fields was found to be reduced and changes in the spine morphology, as well as reduction in spine density, were observed. However, a simultaneous lengthening of the terminal dendrites of higher order gave some evidence for repair mechanisms and neuronal plasticity. The AN-specific implications of these findings are discussed. The conclusion is that all AN deaths should be reported together with descriptions of causes and cerebral alterations.