title: Infiltrative cervical lesions causing symptomatic occipital neuralgia.
abstract: BACKGROUND
  Occipital neuralgia is a well-recognized cause of posterior head and neck pain that may associate mild sensory changes in the cutaneous distribution of the occipital nerves, lacking a recognizable local structural aetiology in most cases. Atypical clinical features or an abnormal neurological examination are alerts for a potential underlying cause of pain, although cases of clinically typical occipital neuralgia as isolated manifestation of lesions of the cervical spinal cord, cervical roots, or occipital nerves have been increasingly reported.
  
  
  METHODS
  We describe two cases (one with typical and another one with atypical clinical features) of occipital neuralgia secondary to paravertebral pyomyositis and vertebral relapse of multiple myeloma in patients with relevant medical history that aroused the possibility of an underlying structural lesion.
  
  
  CONCLUSIONS
  We discuss the need for cranio-cervical magnetic resonance imaging in all patients with occipital neuralgia, even when typical clinical features are present and neurological examination is completely normal.
authors.affiliation: Hospital Universitario 12 de Octubre, Spain.
authors.forename: F
authors.initials: F
authors.lastname: Sierra-Hidalgo
authors.forename: J
authors.initials: J
authors.lastname: Ruíz
authors.forename: A
authors.initials: A
authors.lastname: Morales-Cartagena
authors.forename: A
authors.initials: A
authors.lastname: Martínez-Salio
authors.forename: J de la
authors.initials: Jde L
authors.lastname: Serna
authors.forename: J
authors.initials: J
authors.lastname: Hernández-Gallego
mesh_terms: D000328:Adult; D006261:Headache / Q000209:etiology* / Q000473:pathology / Q000503:physiopathology; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009101:Multiple Myeloma / Q000150:complications* / Q000473:pathology / Q000503:physiopathology; D019547:Neck Pain / Q000209:etiology* / Q000473:pathology / Q000503:physiopathology; D009778:Occipital Lobe / Q000473:pathology* / Q000503:physiopathology; D013290:Streptococcal Infections / Q000150:complications* / Q000473:pathology / Q000503:physiopathology; D013292:Streptococcus agalactiae