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Abstract Details

Occipital Neuralgia Secondary to an Occipital Bone Lesion Revealing Multiple Myeloma
Headache
P9 - Poster Session 9 (5:30 PM-6:30 PM)
15-004

To date, occipital neuralgia has been associated with cervical lesions and cervical stenosis making interventions such as occipital nerve blocks, cervical epidural injections, neuropathic pain agents and physical therapy effective therapeutic options. We report a case of right sided occipital neuralgia in which imaging confirmed a right occipital bone lesion eventually leading to the diagnosis of multiple myeloma.

To emphasize the need for imaging and consideration for alternative etiologies in patients with occipital neuralgia presenting with uncommon symptomology.

A 65-year-old woman with no known medical history presented with sharp shooting pain radiating from the right occiput upward for the last 3 months. She additionally described neck pain radiating down the right arm with a patchy distribution of numbness associated with paresthesias in the right arm. She denied any weakness, gait imbalance, or bowel/bladder dysfunction. Her physical exam was significant for right occipital notch tenderness and hyperreflexia. Due to the new onset of her symptoms, age, and unusual features, a MRI brain with and without contrast, MRA head/neck and MRI cervical spine were ordered.

MRI cervical spine revealed multiple levels of mild cervical spine degenerative disc disease with no significant cord compression. MRI brain revealed a right occipital bone lesion concerning for metastasis. Due to this finding, CT C/A/P and PET scan did not reveal any evidence of a primary malignancy. A skeletal survey was obtained which demonstrated multiple sites of bony involvement. Additional evaluation including immunohistochemistry eventually revealed the diagnosis of multiple myeloma for which treatment  was initiated. Occipital neuralgia symptomatically responded to an occipital nerve block, duloxetine, and physical therapy appropriately.

The phenotypic spectrum of occipital neuralgia shows significant clinical variability, but persistent new focal neurologic deficits should raise suspicion for alternative pathology.

Authors/Disclosures
Anvita Suneja
PRESENTER
Miss Suneja has nothing to disclose.
Maryann Mays, MD, FAAN (Cleveland Clinic) Dr. Mays has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for CoolTech Medical. Dr. Mays has received personal compensation in the range of $10,000-$49,999 for serving on a Speakers Bureau for Abbvie. The institution of Dr. Mays has received research support from Amgen.
Aarushi Suneja, MD (Cleveland Clinic Foundation) Dr. Suneja has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Abbvie. Dr. Suneja has received personal compensation in the range of $5,000-$9,999 for serving on a Speakers Bureau for Abbvie.