by Yosef Laviv*, MD, Matthew P. Anderson** and Ekkehard M. Kasper*, MD PhD

* Department of Surgery, Division of Neurosurgery and ** Departments of Neurology/Pathology; Beth Israel Deaconess Medical Center, Harvard Medical School; Boston, MA USA

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)

Figure 1

Figure 1

* 1. Given the location of the lesion, its mixed solid and cystic morphology and the patient’s neurological exam, what is the most likely diagnosis?