Case History/Examination
An 82 year-old male initially presented with a 6-week history of gradual onset occipital headache, dizziness and ataxia. MRI brain demonstrated a mixed solid cystic right cerebellar lesion measuring 41x41x36mm (Image 1 ). He denied a history of falls, visual disturbance, weight loss or other infective symptoms. Neurological examination did not demonstrate cranial nerve abnormalities or focal weakness. An ataxic gait was present in keeping with the location of the metastases. There were no palpable neck lumps, pain, dysphagia or dysphonia.
Other medical co-morbidities included hypertension, type 2 diabetes, hypercholesterolaemia and reflux. He was a non-smoker, and family history was significant for a niece with a metastatic cancer of unknown primary. ECOG status was 1.