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JAMA Clinical Challenge | Clinician's Corner

A Pain in the Neck

Javier Munoz, MD; Haythem Ali, MD
JAMA. 2012;308(2):182-183. doi:10.1001/jama.2012.4295.
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Extract

A 68-year-old female smoker recently diagnosed with small cell lungcancer presents with a bulging area on her neck, behind her right ear(Figure 1). The patient denies headache or vomiting. Physical examination is remarkable for ataxia with chorea, particularly of her right upper extremity, which has remained relatively unchanged for the last few years. The patient has a history of hemangioblastoma resected 12 years earlier, which recurred after 3 years, at which time she had a second resection and radiation therapy, with poor follow-up since then.

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Topics

neck ; pain

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Figures

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Figure 1. Bulge on the patient's neck, behind her right ear.
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Figure 2. A, Magnetic resonance imaging showing a large heterogeneously enhancing mass occupying most of the right cerebellar region. B, The tumor extends beyond the skull.
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The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
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