RT Journal A1 Munoz J, Ali H T1 A pain in the neck JF JAMA JO JAMA YR 2012 FD July 11 VO 308 IS 2 SP 182 OP 183 DO 10.1001/jama.2012.4295 UL http://dx.doi.org/10.1001/jama.2012.4295 AB 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.