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

J. Q. Purnell, D. L. Lahna, M. H. Samuels, W. D. Rooney, W. F. Hoffman

Research output: Contribution to journalArticlepeer-review

6 Scopus citations


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.

Original languageEnglish (US)
Pages (from-to)1573-1577
Number of pages5
JournalInternational Journal of Obesity
Issue number12
StatePublished - Dec 11 2014


  • bariatric surgery
  • brainstem
  • diffusion tensor imaging
  • magnetic resonance imaging

ASJC Scopus subject areas

  • Medicine (miscellaneous)
  • Endocrinology, Diabetes and Metabolism
  • Nutrition and Dietetics


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