Multiple myeloma with multiple neurological presentations

Published on Dec 1, 2019in Practical Neurology
· DOI :10.1136/PRACTNEUROL-2019-002205
Nicholas James Smith1
Estimated H-index: 1
(Leeds Teaching Hospitals NHS Trust),
Katja Kimberger1
Estimated H-index: 1
(Leeds Teaching Hospitals NHS Trust)
+ 3 AuthorsJane E. Alty12
Estimated H-index: 12
(Leeds Teaching Hospitals NHS Trust)
Multiple myeloma is a haematological malignancy with clonal plasma cell proliferation and production of monoclonal immunoglobulins. Its neurological complications are relatively common, caused by both the disease and the treatment. Neurologists should therefore be familiar with its neurological manifestations and complications. We describe a 40-year-old woman who presented with lower cranial neuropathies mimicking variant Guillain-Barre syndrome, with normal brain and spinal cord imaging and cerebrospinal fluid (CSF) albuminocytological dissociation, and subsequently diagnosed with IgD myeloma. She relapsed repeatedly with differing neurological presentations: numb chin syndrome and twice with impaired vision, first from cerebral venous sinus thrombosis and later from leptomeningeal infiltration of the optic chiasm. We discuss the neurological complications of myeloma, emphasising the need to consider it in a wide variety of neurological presentations and repeatedly to reassess its associated neurological diagnoses. We also highlight the complexity of myeloma treatment.
📖 Papers frequently viewed together
2 Citations
5 Authors (Kumar Br, ..., Sehgal S)
Abstract Introduction The estimated involvement of the central nervous system in patients with multiple myeloma is rare at about 1%. The infiltration can be identified at the time multiple myeloma is diagnosed or during its progression. However, it is more common in refractory disease or during relapse. Methods This retrospective cohort study reviewed data from medical records of patients followed up at the Gammopathy Outpatient Clinic of Santa Casa de Misericordia de Sao Paulo from January 2008...
8 CitationsSource
#1Artur Jurczyszyn (Jagiellonian University Medical College)H-Index: 17
#2Norbert Grzasko (Medical University of Lublin)H-Index: 3
Last. Jorge J. Castillo (Harvard University)H-Index: 59
view all 51 authors...
The multicenter retrospective study conducted in 38 centers from 20 countries including 172 adult patients with CNS MM aimed to describe the clinical and pathological characteristics and outcomes of patients with multiple myeloma (MM) involving the central nervous system (CNS). Univariate and multivariate analyses were performed to identify prognostic factors for survival. The median time from MM diagnosis to CNS MM diagnosis was 3 years. Thirty-eight patients (22%) were diagnosed with CNS invol...
43 CitationsSource
#1Patrizio MazzaH-Index: 24
#2G PalazzoH-Index: 6
Last. G PisapiaH-Index: 2
view all 5 authors...
Autologous and allogeneic stem cell transplant in Jehovah’s Witnesses: a single-center experience on 22 patients
4 CitationsSource
#1Ammar Kheder (Royal Hallamshire Hospital)H-Index: 5
#2Nigel Hoggard (Royal Hallamshire Hospital)H-Index: 28
Last. Simon J. Hickman (Royal Hallamshire Hospital)H-Index: 9
view all 3 authors...
A 51-year-old man presented to the neurology clinic with numbness affecting the left side of his chin, which had developed over a few days. Three weeks later, he reported pain affecting the left side of his face, locking of the jaw on chewing and numbness of the left side of the tongue. He worked as a maintenance fitter in a sewage works and had suffered exposure to raw sewage 2 months before his clinic visit, followed by diarrhoea and vomiting. Serological testing for leptospirosis was negative...
2 CitationsSource
#1Flora Zagouri (UoA: National and Kapodistrian University of Athens)H-Index: 29
#2Efstathios Kastritis (UoA: National and Kapodistrian University of Athens)H-Index: 66
Last. Meletios A. Dimopoulos (UoA: National and Kapodistrian University of Athens)H-Index: 145
view all 11 authors...
IgD multiple myeloma is a rare variant of the disease and in various series accounts for about 2% of patients with symptomatic myeloma. It has been suggested that patients with IgD myeloma may have an inferior outcome when compared to other patients. However, data on IgD myeloma patients treated in the novel agent era are lacking. In order to assess the frequency and evaluate the outcome and the specific characteristics of patients with IgD myeloma we analyzed the database of the Greek Myeloma S...
1 CitationsSource
#1Shivlal Pandey (Mayo Clinic)H-Index: 3
#2Robert A. KyleH-Index: 174
Although survival of patients with IgD or IgE multiple myeloma is shorter in comparison to those with IgG or IgA multiple myeloma, the outcome for patients with IgD and IgE subtypes is improving with the use of novel agents and autologous transplantation.
27 Citations
#1Christine Chen (Princess Margaret Cancer Centre)H-Index: 32
#2Esther Masih-Khan (Princess Margaret Cancer Centre)H-Index: 12
Last. Donna Reece (Princess Margaret Cancer Centre)H-Index: 19
view all 12 authors...
Summary Involvement of the central nervous system (CNS) in multiple myeloma (MM) is a rare complication, with reported survival of <6 months. This report describes 37 MM patients with leptomeningeal and/or parenchymal brain involvement treated at our institution and identifies factors associated with long-term survival. From January 1999 to December 2010, 37 patients with CNS MM were evaluated at our institution. Clinical characteristics, treatment and survival were retrospectively collected. CN...
60 CitationsSource
#1Alina S. Gerrie (UBC: University of British Columbia)H-Index: 17
#2Joseph R. Mikhael (Mayo Clinic)H-Index: 46
Last. Christine ChenH-Index: 32
view all 11 authors...
Summary Dexamethasone ± thalidomide with infusion of cisplatin, doxorubicin, cyclophosphamide, and etoposide [D(T)PACE] is generally reserved as salvage therapy for aggressive multiple myeloma (MM) or plasma cell leukaemia (PCL) resistant to conventional therapies. The efficacy and durability of this potentially toxic regimen in this setting is unclear. We identified 75 patients who received D(T)PACE for relapsed/refractory MM at two tertiary care centres: Princess Margaret Hospital, Toronto and...
34 CitationsSource
#1Alessandro GozzettiH-Index: 32
#2Alfonso CeraseH-Index: 28
Last. Francesco LauriaH-Index: 42
view all 15 authors...
BACKGROUND: Intracranial involvement in multiple myeloma is extremely rare. The effect of new drugs (eg, thalidomide, bortezomib, lenalidomide) with respect to old drugs (eg, alkylators, steroids) has not been reported. METHODS: We collected clinical and biological data of patients presenting with an osteo-dural or primary dural multiple myeloma (OD-DMM) or a central nervous system myelomatosis (CNS-MM) by sending a questionnaire to the centers of the Gruppo Italiano Malattie Ematologiche dell'A...
65 CitationsSource
#1Curly MorrisH-Index: 16
#2M. DrakeH-Index: 13
Last. G. GahrtonH-Index: 25
view all 12 authors...
Background As rare myelomas, i.e. the IgD, IgE, IgM and non-secretory forms, constitute only a small proportion of any study, relatively little is known about their prognosis in the era of peripheral stem cell transplantation. Design and Methods We used the European Group for Blood and Marrow Transplantation Myeloma Database to compare the outcome following autologous transplantation of over 20,000 patients with common myelomas (IgG, IgA and light chain myeloma) with the outcome of patients with...
29 CitationsSource
Cited By3
Patients with hematological diseases often experience cerebrovascular complications including ischemic stroke, intracerebral and subarachnoid hemorrhage, microbleeds, posterior reversible encephalopathy syndrome, and dural sinus and cerebral vein thrombosis (CVT). In this update, we will review recent advances in the management of cerebrovascular diseases in the context of myeloproliferative neoplasms, leukemias, lymphomas, multiple myeloma, POEMS, paroxysmal nocturnal hemoglobinuria (PNH), thro...
#1Amit Kumar Sharma (UWO: University of Western Ontario)H-Index: 1
#1Amit Kumar Sharma (UWO: University of Western Ontario)H-Index: 2
Last. Seth A. Climans (UWO: University of Western Ontario)
view all 3 authors...