Silent but Serious: Astrocytoma in a Seven-Month-Old Infant With Atypical Presentation.

Pilocytic astrocytoma (PA) is a common paediatric brain tumour that usually presents with neurological or visual symptoms linked to its location. This report describes a seven-month-old boy with an unusual presentation marked by poor feeding, progressive weight loss, and recurrent vomiting over three months, without early neurological signs. Extensive initial assessments, including feeding evaluations, multidisciplinary reviews, and pharmacological trials, did not reveal a cause. Ultimately, neuroimaging identified a large suprasellar mass with leptomeningeal deposits. Following lumbar puncture, histopathological examination of the biopsy specimen, and molecular testing, the diagnosis of PA was confirmed. Treatment was subsequently initiated with carboplatin and vincristine. Unlike typical PA cases, which often involve headaches, visual problems, or motor deficits, this case underscores that systemic, nonspecific symptoms can signal central nervous system disease. The report highlights the importance of considering neuroimaging in infants with persistent vomiting and failure to thrive to enable earlier diagnosis and potentially improve outcomes in atypical PA presentations.