Occipital neuralgia as a presenting symptom of gastric cancer metastasis

A 43-year-old female with a history of gastric cancer noted shooting pain in the left occipital region. Each attack lasted one to two seconds, and turning the head triggered the pain. Neurological examination was normal. Cranial MRI showed a left paravertebral lesion of atlas (Figure 1). Chest CT and histopathological results found lung metastases of gastric origin. One month later, MRI demonstrated brain metastases and the paravertebral metastatic lesion had increased in size (Figure 2). Tumors rarely metastasize to the paravertebral region; compression of the upper cervical nerve roots may result in occipital neuralgia (1,2). Relevant medical history should alert clinicians to the possibility of metastasis causing occipital neuralgia.

Figure 1.

T2-weighted cranial MRI showed left paravertebral lesion near atlas (arrow).

Figure 2.

MRI demonstrated the brain metastases (arrowhead) and an increase in metastatic paravertebral lesion one month later (arrow).