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CC BY-NC-ND 4.0 · Arq Neuropsiquiatr 2021; 79(02): 179-180
DOI: 10.1590/0004-282X-anp-2020-0139
Images in Neurology

Leptomeningeal metastasis of multiple myeloma

Metástases leptomeníngeas de mieloma múltiplo
Cristiane Máximo da Silva 
1   Hospital Federal dos Servidores do Estado, Serviço de Neurologia, Rio de Janeiro RJ, Brazil
,
Jamison Menezes de Souza 
2   Hospital Federal dos Servidores do Estado, Serviço de Hematologia, Rio de Janeiro RJ, Brazil
,
Roberto Queiroz dos Santos 
3   Hospital Federal dos Servidores do Estado, Serviço de Radiologia, Rio de Janeiro RJ, Brazil
4   Americas Medical City, Rio de Janeiro RJ, Brazil
,
Mariana Spitz 
1   Hospital Federal dos Servidores do Estado, Serviço de Neurologia, Rio de Janeiro RJ, Brazil
5   Universidade do Estado do Rio de Janeiro, Hospital Universitário Pedro Ernesto, Serviço de Neurologia, Rio de Janeiro RJ, Brazil
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A 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 neuropathy[1]. 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.

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Figure 1 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.
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Figure 2 Cerebrospinal fluid specimen with myelomatous cells (arrow). The stain employed was May-Grunwald-Giemsa. Atypical plasmocytes found in the cerebrospinal fluid were subsequently confirmed by immunophenotyping.

Authors’ contributions:

All authors contributed equally to the article's conception, writing, and review.




Publication History

Received: 04 April 2020

Accepted: 25 July 2020

Article published online:
04 July 2023

© 2021. Academia Brasileira de Neurologia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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  • References

  • 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
  • 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