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Chronic neck pain is an extremely common symptom in the general population. Most cases have underlying musculoskeletal aetiologies and are managed conservatively. However, a very small number of patients presenting with chronic neck pain will have significant underlying pathology, e. g. a spinal cord tumour. Intramedullary spinal cord tumours are uncommon at all ages, particularly in adults, and there are some controversies in their treatment. The case of an 18-year-old man with chronic neck pain who was subsequently shown to have a pilocytic intramedullary astrocytoma is presented. This report highlights the need to consider rare, but potentially serious, diagnoses in individuals presenting with non-resolving, but seemingly innocent, symptoms over a prolonged period.

Insidious onset neck pain – a symptom not to be dismissed