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Intracranial Involvement Of Multiple Myeloma [Turk J Neurol]
Turk J Neurol. 2008; 14(5): 328-332

Intracranial Involvement Of Multiple Myeloma

Özlem Alkan1, Ebru Kızılkılıç2, Tülin Yıldırım1, Mutlu Kasar2, Osman Kızılkılıç1, Mahmut Yeral2, Süheyl Asma2, Semih Giray3, Hakan Özdoğu2
1Department Of Radiology, Baskent University, Faculty Of Medicine, Adana, Turkey
2Department Of Haematology, Baskent University, Faculty Of Medicine, Adana, Turkey
3Department Of Neurology, Baskent University, Faculty Of Medicine, Adana, Turkey

OBJECTIVE: Multiple myeloma is usually restricted to the bone marrow. Central nervous system involvement is uncommon and can be observed in approximately 1% of the multiple myeloma patients. OBJECTIVES: We aimed to demonstrate brain magnetic resonance patterns in patients with multiple myeloma with neurologic symptoms and the literature is reviewed.
METHODS: We retrospectively studied 39 patients with multiple myeloma with neurologic symptoms. All the patients underwent classic and contrast enhanced brain MR examination.
RESULTS: Patients presented with the following symptoms: impaired consciousness (n=8, 20.5%), headache (n=6, 15.3%), hemiparesis (n=2, 5.1%), aphasia (n=6, 15.3%), scalp swelling (n=2, 5.1%), visual loss (n=1, 2.5%), seizure (n=2, 5.1%), vertigo (n=4, 10.2%), ophthalmoplegia (n=4, 10.2%), meningeal irritation findings (n=2, 5.1%), and orientation disorder (n=2, 5.1%). Among 39 patients with multiple myeloma, 14 (35.8%) had ischemic lesions, 14 (35.8%) had calvarial diploic metastases, 5 (12.8%) had dura mater mass, 4 (10.2%) had dura mater involvement, 2 (5.1%) had sinonasal mass, 1 had cavernous sinus and orbital apex mass, 1 (2.5%) had leptomeningeal involvement, 1 (2.5%) had intraorbital mass, 3 (7.6%) had clivus mass, 1 (2.5%) had optic neuritis, 1 (2.5%) had central pontine myelinolysis and 2 (5.1%) had meningitis. Examination of the cerebrospinal fluid was performed in 6 patients. Cerebrospinal fluid studies showed malignant plasma cells in 1 patient with leptomeningeal contrast enhancement. Despite serial cerebrospinal fluid examination, plasma cells in cerebrospinal fluid were not showed in 2 patients with dura mater involvement. Two patients had menengitis.
CONCLUSION: Involvement of the central nervous system in multiple myeloma is very uncommon. The occurrence of neurological symptoms in a patient with myeloma requires an accurate evaluation with MR and lumbar puncture to detect a possible meningeal or cerebral involvement, when metabolic factors (hypercalcemia,drug toxicity, uremia), hyperviscosity, or medullary compression can be excluded.

Keywords: multiple myeloma, central nervous system involvement, MR


Özlem Alkan, Ebru Kızılkılıç, Tülin Yıldırım, Mutlu Kasar, Osman Kızılkılıç, Mahmut Yeral, Süheyl Asma, Semih Giray, Hakan Özdoğu. Intracranial Involvement Of Multiple Myeloma. Turk J Neurol. 2008; 14(5): 328-332

Corresponding Author: Özlem Alkan, Türkiye


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