Leptomeningeal metastasis of multiple myelomaA 65-year-old female with multiple myeloma diagnosed one year before developed tonic-clonic seizures. She had a good initial response to chemotherapy. Brain magnetic resonance imaging (MRI; Figure 1) and cerebrospinal fluid (CSF; Figure 2) analysis showed central nervous system myelomatous infiltration. Intrathecal chemotherapy and dexamethasone were prescribed and a follow-up CSF sample was negative for plasmocytes. Neurologic manifestations of multiple myeloma are not uncommon and include spinal compression and peripheral neuropathy1. Central nervous system myelomatosis, on the other hand, is rare. The workup for the diagnosis includes brain MRI and CSF analysis. CSF cytology has a sensitivity of 50–60% and a specificity over 95%2. Prognosis is poor.
Sagital postcontrast T1-weighted image (1A) shows mixed pachymeningeal and leptomeningeal thickening forming nodules and intense gadolinium enhancement. Axial T2-weighted image (1B) and coronal T1-weighted image (1C) show one of these nodules extending into subjacent brain parenchyma with perilesional edema.
References
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1 Brum M, António AS, Guerreiro R. Myelomatous meningitis: a rare neurological involvement in complete remission of multiple myeloma. J Neurol Sci. 2014 May;340(1-2):241-2. https://doi.org/10.1016/j.jns.2014.03.015
» https://doi.org/10.1016/j.jns.2014.03.015 -
2 Bommer M, Kull M, Teleanu V, Schwarzwälder P, Feuring-Buske M, Kroenke J, et al. Leptomeningeal myelomatosis: A rare but devastating manifestation of multiple myeloma diagnosed using cytology, flow cytometry, and fluorescent in situ hybridization. Acta Haematol. 2018 Aug;139(4):247-54. https://doi.org/10.1159/000489484
» https://doi.org/10.1159/000489484
Publication Dates
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Publication in this collection
19 Mar 2021 -
Date of issue
Feb 2021
History
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Received
04 Apr 2020 -
Reviewed
23 July 2020 -
Accepted
25 July 2020
