By Dr Michael Bryant
A 69 year old male presented to his GP with a slowly progressive, 6 month history of left sided neck pains and occipital headaches. Examination was unremarkable and in particular, strengths and reflexes in all 4 limbs were normal.
CT scan revealed some degenerative changes low down in the cervical facet joints and a referral was made to an orthopaedic spinal specialist, and from here facet joint injections were undertaken.
When this procedure provided no relief, a greater occipital nerve injection was arranged under CT guidance and was on this procedure that the causative pathology was finally identified.
When the MRI scan was finally undertaken, a contrast enhancing, durally based, ventral and left sided tumour was identified behind C1 and C2.
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