title: Neck pain: common complaint, uncommon diagnosis--symptomatic clival chordoma.
abstract: Patients presenting with neck complaints, such as pain or stiffness, are not uncommon in the Emergency Department. Complaints of neck instability, however, are unusual. We report the case of a 30-year-old woman who presented with multiple neck complaints that included having a "wobbly" sensation of her neck on flexion, feeling as if it were unstable. Our patient indeed had atlanto-occipital instability secondary to a locally destructive tumor of the cranial base, known as a clival chordoma. Chordomas are rare and unique bony tumors that arise along the neural axis and are thought to originate from the nucleus pulposus. The tumors are slow growing; locally invasive; and cause a variety of neurologic, musculoskeletal, cranial, and neck complaints. We describe this unique case and its presentations in an attempt to increase the sensitivity of physicians in early detection of this rare and lethal tumor.
authors.affiliation: Division of Emergency Medicine, Department of Surgery, University of Texas Health Science Center at San Antonio, San Antonio, TX 78284-7702, USA.
authors.forename: Ricardo
authors.initials: R
authors.lastname: Alvarado
authors.forename: John
authors.initials: J
authors.lastname: Gomez
authors.forename: Samuel G
authors.initials: SG
authors.lastname: Morale
authors.forename: Charles P
authors.initials: CP
authors.lastname: Davis
mesh_terms: D000328:Adult; D001269:Atlanto-Occipital Joint / Q000503:physiopathology; D002817:Chordoma / Q000175:diagnosis*; D005260:Female; D006801:Humans; D007593:Joint Instability / Q000209:etiology / Q000503:physiopathology; D019547:Neck Pain / Q000209:etiology*; D019292:Skull Base Neoplasms / Q000175:diagnosis*