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JAMA Clinical Challenge
Clinician's Corner
July 11, 2012

A Pain in the Neck

JAMA. 2012;308(2):182-183. doi:10.1001/jama.2012.4295

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.