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Intracranial Involvement in Multiple Myeloma Presenting as a Cranial Nerve Palsy

Multiple myeloma (MM) is characterized by the neoplastic proliferation of plasma cells producing a monoclonal immunoglobulin. Neurological complications in MM most frequently occur due to spinal cord compression by bony lesions, paraprotein-related neuropathy, hypercalcemia, hyperviscosity, or amylo...

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Autores principales: Fitzgerald, Eilis, Kiely, Patrick, Leary, Hilary O
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Elmer Press 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7153671/
https://www.ncbi.nlm.nih.gov/pubmed/32300438
http://dx.doi.org/10.14740/jh468
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author Fitzgerald, Eilis
Kiely, Patrick
Leary, Hilary O
author_facet Fitzgerald, Eilis
Kiely, Patrick
Leary, Hilary O
author_sort Fitzgerald, Eilis
collection PubMed
description Multiple myeloma (MM) is characterized by the neoplastic proliferation of plasma cells producing a monoclonal immunoglobulin. Neurological complications in MM most frequently occur due to spinal cord compression by bony lesions, paraprotein-related neuropathy, hypercalcemia, hyperviscosity, or amyloidosis. Intracranial involvement is a rare complication of MM occurring in only 1% of patients. It can manifest as a solitary cerebral lesion, intra-parenchymal infiltration, or diffuse leptomeningeal disease. We present a case of a leptomeningeal myeloma in a 71-year-old woman with known relapsed MM presenting with a right sixth nerve palsy. Our patient was receiving spinal irradiation for a paraspinal plasmacytoma when she complained of double vision. Clinical exam revealed a right sixth nerve palsy. MRI revealed diffuse abnormal leptomeningeal thickening and enhancement typical for diffuse leptomeningeal infiltration. She was treated with whole brain irradiation and intrathecal methotrexate combined with a lenalidomide and dexamethasone chemotherapeutic regimen but unfortunately she passed away 5 weeks after onset of visual symptoms. MM involving the central nervous system (CNS) is a rare complication of MM and carries a poor prognosis with an average survival of 3 months. Due to its rarity, treatment of CNS MM is very heterogeneous. Thus case reporting is important to accumulate data on this rare presentation.
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spelling pubmed-71536712020-04-16 Intracranial Involvement in Multiple Myeloma Presenting as a Cranial Nerve Palsy Fitzgerald, Eilis Kiely, Patrick Leary, Hilary O J Hematol Case Report Multiple myeloma (MM) is characterized by the neoplastic proliferation of plasma cells producing a monoclonal immunoglobulin. Neurological complications in MM most frequently occur due to spinal cord compression by bony lesions, paraprotein-related neuropathy, hypercalcemia, hyperviscosity, or amyloidosis. Intracranial involvement is a rare complication of MM occurring in only 1% of patients. It can manifest as a solitary cerebral lesion, intra-parenchymal infiltration, or diffuse leptomeningeal disease. We present a case of a leptomeningeal myeloma in a 71-year-old woman with known relapsed MM presenting with a right sixth nerve palsy. Our patient was receiving spinal irradiation for a paraspinal plasmacytoma when she complained of double vision. Clinical exam revealed a right sixth nerve palsy. MRI revealed diffuse abnormal leptomeningeal thickening and enhancement typical for diffuse leptomeningeal infiltration. She was treated with whole brain irradiation and intrathecal methotrexate combined with a lenalidomide and dexamethasone chemotherapeutic regimen but unfortunately she passed away 5 weeks after onset of visual symptoms. MM involving the central nervous system (CNS) is a rare complication of MM and carries a poor prognosis with an average survival of 3 months. Due to its rarity, treatment of CNS MM is very heterogeneous. Thus case reporting is important to accumulate data on this rare presentation. Elmer Press 2019-03 2019-03-30 /pmc/articles/PMC7153671/ /pubmed/32300438 http://dx.doi.org/10.14740/jh468 Text en Copyright 2019, Fitzgerald et al. http://creativecommons.org/licenses/by-nc/4.0/ This article is distributed under the terms of the Creative Commons Attribution Non-Commercial 4.0 International License, which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Case Report
Fitzgerald, Eilis
Kiely, Patrick
Leary, Hilary O
Intracranial Involvement in Multiple Myeloma Presenting as a Cranial Nerve Palsy
title Intracranial Involvement in Multiple Myeloma Presenting as a Cranial Nerve Palsy
title_full Intracranial Involvement in Multiple Myeloma Presenting as a Cranial Nerve Palsy
title_fullStr Intracranial Involvement in Multiple Myeloma Presenting as a Cranial Nerve Palsy
title_full_unstemmed Intracranial Involvement in Multiple Myeloma Presenting as a Cranial Nerve Palsy
title_short Intracranial Involvement in Multiple Myeloma Presenting as a Cranial Nerve Palsy
title_sort intracranial involvement in multiple myeloma presenting as a cranial nerve palsy
topic Case Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7153671/
https://www.ncbi.nlm.nih.gov/pubmed/32300438
http://dx.doi.org/10.14740/jh468
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