Chronic nausea and emesis, which may serve a protective function, pose a diagnostic challenge with a broad differential and contribute to numerous health care visits each year. We present a case of chronic intermittent nausea/emesis due to a brain mass without classic neurologic findings. A 36 year-old male presented with 3 months of intermittent episodes consisting of: relentless nausea, up to 10 bouts of forceful emesis a day, and PO intolerance. Episodes would last 2-3 days and occur once every 6 to 8 weeks with asymptomatic intervals between episodes. He denied preceding events, food triggers, and other related symptoms. He was taking lisinopril and aspirin and denied over the counter supplements. He remained afebrile and hemodynamically stable. Physical exam noted active emesis and non-peritoneal left quadrant pain. CBC, CMP, TSH, lipase were within normal limits. Urine drug screen and EtOH level were negative. CT abdomen/pelvis and right upper quadrant ultrasound were unremarkable. EGD revealed a small hiatal hernia with LA grade B esophagitis, chronic active gastritis, no food retention, and no evidence of obstruction. A trial of high dose PPI was unsuccessful. Subsequent imaging of the brain revealed a 1.6cm right posterior high frontal cortical mass without mass effect that was suspected to be benign; therefore, plan was for conservative management. However, in the following months, the patient had progression of symptoms with episodes increasing to once every 4 weeks and lasting 1-2 weeks. An elective sub-total resection of the mass was performed. Pathology demonstrated a diffuse grade II astrocytoma. The patient reported complete symptom resolutions at his 3-month follow up exam. The most common symptoms associated with brain masses are headache and neurologic deficits. However, nausea/vomiting are the initial presenting symptoms in up to 13% of cases. Nausea/emesis are typically the result of increased intracranial pressure, mass effect, involvement of the posterior fossa leading to gastroparesis, or involvement of the area postrema at the chemoreceptor trigger zone. However, lesions involving the higher cortical centers (such as the frontal lobe) can also lead to nausea and emesis. We highlight a rare case of a frontal astrocytoma initially presenting with unexplained nausea/emesis with resolution of symptoms following resection. It is important to consider the extra-intestinal etiologies for common gastrointestinal symptoms.3085_A Figure 1. MRI Brain Horizontal3085_B Figure 2. MRI Brain Sagittal