Multiple lesions of skull and cervical spine: a rare presentation of unicameral bone cysts

BMJ Case Reports
Kristin HuntoonJames Bradley Elder

Abstract

A 55-year-old man with a history of Benign Paroxysmal Positional Vertigo unalleviated by Epley manoeuvre presented to an otolaryngologist for dizziness, right ear fullness and headache. MRI of the brain showed numerous marrow-replacing lesions throughout the calvarium, skull base and upper cervical spine which were hypointense on T1-weighted images, hyperintense on T2-weighted images and avidly enhanced following contrast, concerning for a malignant process such as metastatic disease or multiple myeloma (figure 1). Systemic X-ray survey (spine, skull, chest, pelvis, all long bones) and nuclear medicine whole body bone scan were negative except for the lesions seen on MRI. β-2microglobin, immunoglobin and monoclonal protein electrophoresis were negative for myeloma or immunological process. Given the concern for metastatic disease, biopsy of a skull lesion was recommended. Pathological analysis of a calvarial lesion was consistent with unicameral bone cyst (figure 1). No ongoing therapy was offered; however, brain and spine surveillance imaging will continue.

References

Jun 1, 1986·The Laryngoscope·G T Nager
Aug 1, 1974·The Canadian Journal of Neurological Sciences. Le Journal Canadien Des Sciences Neurologiques·M BannaB E Tomlinson
Mar 1, 1971·The Laryngoscope·Y NomuraA Komatsuzaki
Aug 22, 2000·The Journal of the American Academy of Orthopaedic Surgeons·R M Wilkins
Feb 22, 2002·Journal of Pediatric Orthopedics·J Sybil Biermann

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