Brain tumors and the area postrema

Brain tumors can rarely present with symptoms mistaken for anorexia nervosa. We report a patient with a long-standing history of anorexia who developed headaches and was found on brain MRI to have a brain tumor in the area of the fourth ventricle. On admission, the patient presented with a 4 month history of headaches and a 10 year history of “anorexia nervosa”. Interestingly, the patient did not endorse the classic sense of an altered self-body image. Her body weight on admission was 37 kg. The patient underwent surgical resection of the tumor. On postoperative day (POD) 1, the patient subjectively reported an increased appetite. On POD 2, we documented that she finished her entire food tray for the first time during her hospital stay. Her peri-operative course was without any complications. She presented for a follow-up clinic visit 2 weeks postoperatively and was noted to have a new body weight of 47 kg (10 kg gain). To our knowledge, this is the first reported occurrence of a sporadic, and third overall occurrence, of a hemangioblastoma that presented with an anorexia nervosa–like syndrome that was ultimately cured with surgical resection. In patients presenting with a history of psychiatric illness, it is important to consider the possibility of underlying, organic pathologies in the central nervous system affecting the relevant neuro-anatomical domains.