Metastases to the skull occur in 25% of all malignancies and of this maximum are from either breast, lung or prostate. Solitary lesions to the skull present eitheras a painless lump or with cranial nerve palsies depending on the location in the skull. Management remains surgery alone or in combination with either radiotherapy / chemotherapy or both. We report an uncommon case of solitary metastases which turned out to be from breast carcinomapost-surgery. Case report:A80-year female came with history of progressively enlarging painless lump over the right back side of head and reduced vision in her right eye for the past 3 months. She had no history of vomiting, seizure or other medical problems .She was a chronic smoker and alcoholic for past 20 years. On examination there was a hard, immobile mass over the right occipital area of 5X5 cm with normal skin and ill-defi ned margins. There was papilledema in the right eye. Computed tomogram/ Magnetic resonance imaging showed a large heterogenous, partly hyperostotic/ osteolytic enhancing mass that had erodedthrough the bone and reaching up to the dural surface (Figure 1). There was no other bony or brain metastases. Chest X-ray, abdominal scan, whole spine screening, hematology and biochemistry were normal.Intraoperatively there was heterogenous fi rm to solid, vascular with trabeculae, extending from the subcutaneous plane and through bone to infi ltrate the dura. Wide resection with 1 cm margin was done of the mass, bone and dura followed by synthetic duroplasty and bone cement cranioplasty. Staples were removed on the 9thpost operativeday and the histopathology reported was surprisingly breast carcinoma. Grossly there is a soft tissue mass with invasion of the bone (Figure 1C), and 40x H&E stain and 100x H&E stain shows atypical cells forming glands and scattered singly with desmoplastic reaction. Some of the cyst shows capillary like projection with pseudostratifi cation (Roman bridge). Bone destruction is also present (Figure 1.D & E).Extensive search for primary in the breast was negative and postoperative CA 125 level was raised.She was advised to get a PET Scan, Mammography and Estrogen/ Progestrone receptor study for further Chemotherapy but the patient relatives refused in view of her age. She was asymptomatic and slight improvement in her vision at one month follow up. Discussion:Metastasis to the skull occurs for around 25% of all malignant cases. Breast (20%), lung and prostate (38%) are the common source of metastases and the others include thyroid, renal, lymphoma, multiple myeloma, colon and melanoma.1 Bone metastases can be present in around 50-70% breast cancer patient as detected by 99mTc scan.2 In comparison dural and brain metastases are rarer in this group (10-15%).

Sellar/suprasellar arachnoid cyst can present with headache, endocrine dysfunction, psychomotor abnormalities, chronic hydrocephalus, vertigo, optic nerve and visual deficits and asymptomatically. We report a case managed with cystocisternostomy and long term follow-up with good improvement of his visual function.Nepal Journal of Neuroscience, Volume 14, Number 1, 2017, Page: 23-24

The eye may be injured by various penetrating and non-penetrating injuries like sticks, pencils, rods, gunshot and chopsticks. Self-inflicted gunshot injuries have been rarely reported in literature. This case is interesting in multiple aspects which include poverty, lack of education and the failure of government to ensure control of the use of firearms in Nepal. We report a case of self-inflicted gun injury which was managed successfully.