Case of Stroke from Cerebral Vasculitis following Carfilzomib, Lenalidomide, and Dexamethasone Therapy in a Patient with Relapsing Multiple Myeloma

Osafehinti, Deborah; Zivari, Kaveh

doi:10.1155/2019/5180424

Cited by 4 publications

(3 citation statements)

References 18 publications

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“…We have described an atypical presentation of multiple myeloma consisting of acute ischemic stroke, dyspnea, and moderate abdominal pain due to underlying thrombosis. Prior literature has also shown a few case reports that have described incidences of stroke in patients with multiple myeloma although most of the incidences were a consequence of chemotherapeutic drugs such as lenalidomide and carfilzomib among others [7,8]. There have been prior reports of patients with multiple myeloma having arterial as well as venous thrombotic episodes, however, they have been attributed to treatment regimens consisting of thalidomide and dexamethasone [9,10].…”

Section: Discussionmentioning

confidence: 99%

An unorthodox presentation of multiple myeloma in the form of acute ischemic stroke, dyspnoea, thromboses in multiple arteries and abdominal pain: A case report

Tambolkar¹,

Tambolkar²,

Navandar³

2022

Indian J Case Reports

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A patient with multiple myeloma usually presents with pathologic fractures, renal failure, anemia, and recurrent bacterial infections. Instead, this patient presented with acute ischemic stroke, dyspnea, and abdominal pain. The following case could be of immense clinical significance due to the unorthodox presenting features of the patient. A 55-year-old Indian male, a known hypertensive with a history of COVID-19, presented with features of acute ischemic stroke, breathlessness, and moderate abdominal pain. After treating the stroke, USG abdomen and pelvis were done which showed aortic, splenic, and right renal arterial thrombosis. Following suspicious laboratory results, a bone marrow biopsy was performed which revealed 12–15% plasmacytosis. Serum electrophoresis showed a band of M-protein suggestive of multiple myeloma. Multiple myeloma is rare and the aforementioned symptoms are even rarer which could pose a diagnostic challenge to clinicians. Clinicians should consider the possibility of multiple myeloma in similar cases in the future.

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Section: Discussionmentioning

confidence: 99%

An unorthodox presentation of multiple myeloma in the form of acute ischemic stroke, dyspnoea, thromboses in multiple arteries and abdominal pain: A case report

Tambolkar¹,

Tambolkar²,

Navandar³

2022

Indian J Case Reports

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“…An increase in ischemic or hemorrhagic risk is also reported in patients with multiple myeloma linked in particular to hypercoagulability, hyperviscosity, thrombotic microangiopathy, and embolism [121][122][123]. Furthermore, many drugs used for these pathological forms can have thrombogenic side effects [124]. Thrombotic and thrombocytopenic purpura can cause ischemic or hemorrhagic strokes even at a young age, usually with multifocal onset with involvement of the large arteries [125].…”

Section: Pathological Condition and Risk Of Ischemic Or Hemorrhagic S...mentioning

confidence: 99%

Hemorrhagic Coagulation Disorders and Ischemic Stroke: How to Reconcile Both?

Crispino

2023

Neurology International

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Coagulation and fibrinolytic system disorders are conditions in which the blood’s ability to clot is impaired, resulting in an increased risk of thrombosis or bleeding. Although these disorders are the expression of two opposing tendencies, they can often be associated with or be a consequence of each other, contributing to making the prognosis of acute cerebrovascular events more difficult. It is important to recognize those conditions that are characterized by dual alterations in the coagulation and fibrinolytic systems to reduce the prognostic impact of clinical conditions with difficult treatment and often unfortunate outcomes. Management of these individuals can be challenging, as clinicians must balance the need to prevent bleeding episodes with the potential risk of clot formation. Treatment decisions should be made on an individual basis, considering the specific bleeding disorder, its severity, and the patient’s general medical condition. This review aims to deal with all those forms in which coagulation and fibrinolysis represent two sides of the same media in the correct management of patients with acute neurological syndrome. Precision medicine, personalized treatment, advanced anticoagulant strategies, and innovations in bleeding control represent future directions in the management of these complex pathologies in which stroke can be the evolution of two different acute events or be the first manifestation of an occult or unknown underlying pathology.

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“…Patients with multiple myeloma (MM) are at increased risk of ischemic and hemorrhagic stroke and cerebral venous thrombosis [ 28 , 33 ]. In MM, ischemic stroke can occur through several pathophysiological mechanisms including hypercoagulability (e.g., abnormal plasma thrombin generation, microparticle-associated tissue factor, high PAI-1 levels, increased P-selectin, and acquired activated Protein C resistance) [ 34 , 35 ] hyperviscosity, thrombotic microangiopathy, embolism from an amyloid cardiomyopathy and thrombogenic side-effects of medications such as lenalidomide [ 36 ], thalidomide, bortezomib, carfilzomib [ 37 ], dexamethasone, and erythropoiesis-stimulating agents [ 38 ].…”

Section: Multiple Myelomamentioning

confidence: 99%

Cerebrovascular manifestations in hematological diseases: an update

Ferro

Infante

2021

J Neurol

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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), thrombotic thrombocytopenic purpura (TTP), and sickle-cell disease. In acute ischemic stroke associated with hematological diseases, thrombectomy can in general be applied if there is a large vessel occlusion. Intravenous thrombolysis can be used in myeloproliferative neoplasms and sickle-cell anemia, but in other diseases, a case-by-case evaluation of the bleeding risks is mandatory. Patients with sickle-cell disease and acute stroke need very often to be transfused. In PNH, acute ischemic stroke patients must be anticoagulated. Most patients with CVT can be treated with low-molecular weight heparin (LMWH) acutely, even those with leukemias. Prevention of recurrence of cerebral thrombotic events depends on the control of the underlying disease, combined in some conditions with antithrombotic drugs. The recent introduction of specific monoclonal antibodies in the treatment of PHN and TTP has dramatically reduced the risk of arterial and venous thrombosis.

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Case of Stroke from Cerebral Vasculitis following Carfilzomib, Lenalidomide, and Dexamethasone Therapy in a Patient with Relapsing Multiple Myeloma

Cited by 4 publications

References 18 publications

An unorthodox presentation of multiple myeloma in the form of acute ischemic stroke, dyspnoea, thromboses in multiple arteries and abdominal pain: A case report

An unorthodox presentation of multiple myeloma in the form of acute ischemic stroke, dyspnoea, thromboses in multiple arteries and abdominal pain: A case report

Hemorrhagic Coagulation Disorders and Ischemic Stroke: How to Reconcile Both?

Cerebrovascular manifestations in hematological diseases: an update

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