Case Description
A previously healthy 34-year-old man, while investigated for a cystic swelling in the submandibular area (cystic hygroma), was incidentally diagnosed with an isolated osteolytic lesion located in the left C7 lateral mass (see Image 1). The patient did not complain of any symptom but an unspecific neck pain, and was referred for spinal consultation to our Out-Patient Clinic. On neurological examination he showed a mildly reduced range of motion of the cervical spine and a subtle left radiculopathy, characterized by reduced sensation (8/10) in the forearm, ventral palm and fifth finger; he otherwise showed intact strength in upper and lower limbs (5/5 bilaterally) and normal reflexes (2+ bilaterally). To further investigate the nature of this lesion a contrast-enhanced MRI of the cervical spine was performed (see Image 2); furthermore, neurophysiological studies (EMG/NCS) confirmed an irritation of the left C7-C8 nerve roots.