Presentation
This 42-year-old female presented with nuchal and cervical headaches for 3 months. Headaches were getting progressively worse to the point that she could no longer sleep and they were accompanied by a sense of vertigo and nausea. She denied hearing loss, tinnitus, imbalance, falls, dysarthria, dysphonia, diplopia, or dysphagia. Her past medical history included depression and bilateral inguinal hernia repair. Her family history was negative for any malignancies. On exam, limited range of motion of the neck was noted due to pain (especially when turning to the right). Her neurological exam was remarkable only for right sided tongue hemiatrophy. A brain MRI demonstrated the following lesion: (Figure 1)