Further history eventually obtained confirmed a history of nasopharyngeal cancer 20 years ago, treated with chemotherapy and radiotherapy.

The clues, in this case, were the distribution of microhemorrhages, the fatty replacement and other radiation-induced changes, as well as the ethnicity of the patient.

Nasopharyngeal carcinoma is a fairly rare malignancy in most of the western world (annual incidence of less than 1 per 100,000) but has far higher prevalence, particularly among Chinese (up to 25 per 100,000), South-East Asian, and some Middle Eastern populations ¹.