Gourmand Syndrome

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Joanna Ekabua, M.D. [2]

Synonyms and keywords:: Gourmand Syndrome

Overview

Gourmand syndrome is a benign, non-disabling eating disorder that arises as a result of a lesion to the right anterior cerebral hemisphere. Gourmand syndrome mainly involves the anterior cortico-limbic regions. Patients with gourmand syndrome are preoccupied with fine food reflecting a reduced cortical control of visceral impulses. Eating behavior that arises as a result of gourmand syndrome does not correlate with any known category of eating disorders. Prominent cognitive symptoms associated with Gourmand syndrome include; visual-spatial dysfunctions, impaired learning and recall of figures, recalling of a geometric figure when 90 degrees rotated, poor performance in figural fluency and verbal fluency, and left hemispatial neglect Common risk factors in the development of Gourmand syndrome are vascular, brain tumor, trauma, and epilepsy. There is currently no treatment for gourmand syndrome.

Historical Perspective

• There is limited information about the historical perspective of gourmand syndrome.
• Gourmand syndrome was first described in 1997
• Gourmand syndrome is derived from the French word gourmand which means someone who heartily enjoys eating fine foods and drinks. Although commonly not considered a pathology, gourmand eating may sometimes indicate focal brain damage.

Classification

• There is no established system for the classification of gourmand syndrome but it has been grouped into 2 main groups
  • The fine dining habits and changes to taste.
  • The obsessive component.

Pathophysiology

• The pathogenesis of Gourmand syndrome is characterized by a lesion to the right cerebral hemisphere with the involvement of the cortical areas, basal ganglia, or limbic structures.
• Basal ganglia

Image demonstrating the basal ganglia (red) (Picture courtesy: Wikipedia)

• Limbic structures.

Image demonstrating the lobes of the brain (Picture courtesy: Wikipedia)

• Right middle cerebral artery hemorrhagic infarction is the most common implicated cause.
  • Areas supplied by Middle cerebral artery

Image showing areas supplied by the middle cerebral artery (pink) (Picture courtesy: Wikipedia)

• Lesions are found frontal and temporal lobes of the brain.

Image demonstrating the lobes of the brain (Picture courtesy: Medlineplus)

• Prominent neurologic findings indicate focal right-sided damage.
  • Left-sided hemisyndromes; most frequent were 9 sensory-motor and 6 motor.
  • Left-sided visual field defects (5 hemianopsia, 4 quadrantanopias).
  • Epileptic seizures were recorded in 10 patients (7 complex partial seizure of focal right temporal origin).
  • Neurological status was normal in 12 patients with abnormal mental status.
• Gourmand syndrome symptoms arises in an average of 8 months after brain trauma.

Causes

Common causes of gourmand syndrome include

• Right middle cerebral artery infarction
• Brain tumor
• Concussion with haemorrhage
• Epilepsy

Differentiating Gourmand Syndrome From Other Diseases

• Gourmand syndrome must be differentiated from
  • Eating disorder not otherwise specified
  • Binge eating
  • Compulsive overeating
  • Atypical depression

Epidemiology and Demographics

• There is no information on the prevalence of gourmand syndrome. 36 people had been diagnosed with gourmand syndrome as of 2001.
• Gourmand syndrome is more commonly observed among patients aged 15-77years old.
• There is no racial predilection to gourmand syndrome
• Gourmand syndrome affects men and women equally.
• There is no geographical preposition of gourmand syndrome.

Risk Factors

Common risk factors in the development of Gourmand syndrome are

• Vascular
  • Infarction
  • Malformations
  • AVM
  • Aneurysm
• Brain tumor
  • Glioma
  • Meningioma
  • Tuberculoma
• Trauma
  • Concussion with haemorrhage
• Epilepsy
  • Hippocampal sclerosis
  • Cortical dysplasia

Screening

• There is insufficient evidence to recommend routine screening for gourmand syndrome.

Natural History, Complications, and Prognosis

• Early clinical features include a new-found obsession with fine foods and wanting to eat, talk and write about fine foods.
• Common complication of gourmand syndrome is obesity.
• There is no established data on the prognosis of gourmand syndrome.

Diagnosis

Diagnostic Study of Choice

• The diagnosis of gourmand syndrome is made when there is a change in eating behavior post brain trauma.

History and Symptoms

• The hallmark of gourmand syndrome is finding a positive history of
  • Reduced to excessive appetite
  • Hunger dysregulation
  • Satiety signal dysregulation
  • Preoccupation with the preparation and eating of fine quality foods.
  • Outgoing and eating-oriented behavior
  • Aroused only by conversations about food; wanting talk and write about refined foods
  • Desires for homemade meals become more precise and exotic
  • More concerned by quality rather than quantity of food
  • Weight gain
  • Depression
  • Compulsive episode
  • Psyschotic episode

Physical Examination

• Patients with Gourmand syndrome usually appear normal.

• Physical examination may be remarkable for:
  • Severe left sensory-motor hemisyndrome
  • Left hemispatial neglect
  • Impaired figural memory and figural fluency
  • Mild extinction of left visual and tactile stimuli
  • Left-sided astereognosis
  • Poor impulse control
    • Hyperverbality
    • Disinhibition
    • Heightened aggression and drive
    • Affective Lability
    • Indifference.

Laboratory Findings

• There are no specific laboratory findings associated with gourmand syndrome

Electrocardiogram

• There are no ECG findings associated with gourmand syndrome.

X-ray

• There are no x-ray findings associated with gourmand syndrome.

Ultrasound

• There are no ultrasound findings associated with gourmand syndrome.

CT Scan

CT may demonstrates hemorrhagic infarct in the distribution of the right middle cerebral artery, involving the

• Cerebral hemisphere
• Internal capsule
• Basal ganglia

CT demonstrating acute hemorrhagic infarct in the distribution of the right middle cerebral artery involving the right internal capsule and basal ganglia (right side on image corresponds to right hemisphere) (Picture courtesy: Neurology)

MRI

• There are no MRI findings associated with gourmand syndrome.

Other Imaging Findings

• There are no other imaging findings associated with gourmand syndrome.

Other Diagnostic Studies

• There is no diagnostic study for gourmand syndrome.

Treatment

Medical Therapy

• There is no treatment for gourmand syndrome; the mainstay of therapy is supportive care.

Surgery

• There is no surgical treatment for gourmand syndrome.

Primary Prevention

• There are no primary preventive measures available for gourmand syndrome.

Secondary Prevention

• There are no secondary preventive measures available for gourmand syndrome.

References

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