Intracranial Involvement Of Multiple Myeloma

Özlem Alkan; Ebru Kızılkılıç; Tülin Yıldırım; Mutlu Kasar; Osman Kızılkılıç; Mahmut Yeral; Süheyl Asma; Semih Giray; Hakan Özdoğu

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

Keywords: multiple myeloma, central nervous system involvement, MR

Abstract

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.