title: Anorexia: an early sign of fourth ventricle astrocytoma in children.
abstract: BACKGROUND
  Paediatric low-grade astrocytomas of the fourth ventricle are rare tumours, generally revealed by hydrocephalus. However, some patients present with a history of severe anorexia. It might be a harbinger, which if recognized, could lead to earlier diagnosis. We decided to examine our database in order to evaluate the incidence and signification of anorexia in this context.
  
  
  METHODS
  Retrospective monocentric study of cases of low-grade astrocytomas of the fourth ventricle operated between 1991 and 2012 in our paediatric neurosurgery department. We particularly observed the clinical presentation and long-term clinical, oncological and radiological evolution. Non-parametrical tests were used (Mann-Whitney, Fisher).
  
  
  RESULTS
  We reviewed 34 cases, 31 pilocytic astrocytomas and 3 diffuse astrocytomas, 16 boys and 18 girls, (M/F ratio 0.89). Mean age at diagnosis was 8 years old. Seven presented with notable anorexia, the average BMI in this group was ≤2 standard deviation (SD); with clinical signs evolving for 11.5 months. Twenty-seven children had no anorexia; average BMI in this group was +1 SD, with clinical evolution for 6 months on an average of p < 0.05. We found no significant difference regarding hydrocephalus or tumour location. In all children with anorexia, body mass index improved markedly in the postoperative follow-up, which lasted, on average, for 6 years.
  
  
  CONCLUSIONS
  Anorexia with stunted body weight curve is a non-exceptional presentation in children with low-grade astrocytomas of the fourth ventricle. Unexplained or atypical anorexia with negative etiologic assessment should prompt cerebral imaging. Clinical improvement after surgical resection, could suggest a possible interaction between tumour tissue and appetite-suppressing peptide secretion.
authors.affiliation: Pediatric Neurosurgery Unit, University Hospital, Lille, France.
authors.forename: Henri-Arthur
authors.initials: HA
authors.lastname: Leroy
authors.forename: Marc
authors.initials: M
authors.lastname: Baroncini
authors.forename: Isabelle
authors.initials: I
authors.lastname: Delestret
authors.forename: Vincent
authors.initials: V
authors.lastname: Florent
authors.forename: Matthieu
authors.initials: M
authors.lastname: Vinchon
mesh_terms: D000293:Adolescent; D000855:Anorexia / Q000453:epidemiology / Q000209:etiology* / Q000601:surgery; D001835:Body Weight; D002551:Cerebral Ventricle Neoplasms / Q000175:diagnosis* / Q000453:epidemiology / Q000601:surgery; D002648:Child; D002675:Child, Preschool; D042241:Early Diagnosis; D005260:Female; D020546:Fourth Ventricle / Q000601:surgery; D006801:Humans; D015994:Incidence; D007223:Infant; D008297:Male; D009460:Neurologic Examination; D012189:Retrospective Studies; D018709:Statistics, Nonparametric