Cavernous Sinus Syndrome Associated with Nonsecretory Myeloma.

Kyoda, Katsunori; Nakamura, Shinobu; Takeshima, Minoru; Matano, Sadaya; Masuda, Shinji; Matsuda, Tamotsu; Miyakoshi, Hisatsugu

doi:10.2169/internalmedicine.38.988

Cited by 8 publications

(5 citation statements)

References 12 publications

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“…Santral sinir sistemi miyeloması; lokalize parankimal formlarda olabileceği gibi, leptomeninks veya kraniyal sinir tutulumu şeklinde de karşımıza çıkabilir (9). Kavernöz sinüs tutulumu ise çok nadir bildirilmiştir ve kötü prognozla birliktedir (7,11,12). Radyolojik olarak doğrulanması gereklidir (6,7).…”

Section: Discussionunclassified

Cavenous Involvement in a Paint with Multiple Myeloma

Yıldız¹,

Tunçel²,

Yurttutan³

et al. 2018

atfm

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Multipl miyelom plazma hücrelerinin neoplastik proliferasyonuyla seyreden sistemik bir hastalıktır (1). Multipl miyelomun ekstramedüller tutulumu nadirdir ve sadece hastaların %3-5'inde görülür. Genellikle deri, nazofarinks, larinks, üst solunum yolu ve merkezi sinir sistemi (MSS) etkilenir. MSS tutulumu, hastaların tahminen %1'inde görülür (2). Multipl miyelomlu hastalarda orbital tutulum, santral sinir sistemi tutulumları içinde seyrektir (3). İkinci, 3. ve 6. kraniyal sinir tutulumu sık görülür, 6. kraniyal sinir tutulumu bunlar içinde en sık olanıdır (2). Kavernöz sinüs tutulumu ise çok nadirdir ve tedaviye dirençli hastalıkla ve kötü sonuçla birliktedir (5). Multipl myeloma is a systemic disease with neoplastic proliferation of plasma cells. Cavernous sinus involvement is rare in multipl myeloma. The role of imaging with MRI to exclusion of involvement is great because the cavernous sinus can be evaluated very well by magnetic resonance imaging (MRI). Our case, a seventy seven-year-old female patient, applied to our policlinic with visual disturbance in the left eye. In the neurological examination of the patient; left eye was inside in the primer position, bilateral external view limitation was present marked in the left eye and downward view limitation was present in the left eye. Patient's brain MRI showed patchy and nodal signals in the frontoparietal lob borderzone area may be compatible with infarct and causing asymmetric enhancement of the left cavernous sinus and expanding soft tissue lesion was detected. The patient was evaluated as multiple myeloma-associated left cavernous sinus involvement and the patient was directed to oncologic treatment center to re-evaluate her oncologic therapy. Since cavernous sinus involvement is rare in multiple myeloma, we found this patient worthy to present.

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Section: Discussionunclassified

Cavenous Involvement in a Paint with Multiple Myeloma

Yıldız¹,

Tunçel²,

Yurttutan³

et al. 2018

atfm

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“…Multiple cranial neuropathies in combination such as Foster Kennedy syndrome, cavernous sinus syndrome, Gradenigo syndrome and jugular foramen syndrome had been reported in late stages of MM. [3][4][5] Multiple CNs involvements as the initial presentation for plasmacytoma had been reported very rarely only. [6][7][8]11] Ko et al [6] reported a case of the intracranial plasmacytoma in the cavernous sinus presented as left IV and partial V CN palsy.…”

Section: Discussionmentioning

confidence: 99%

“…[2] Multiple cranial neuropathies had been reported in late stages of MM. [3][4][5] Very rarely multiple cranial nerves (CN) involvement by plasmacytoma may be presenting feature of MM. [6][7][8] Here, we report a case of multiple CN palsy (right 3 rd , 6 th , 9 th , 10 th and 12 th CNs) as first presentation of the intracranial plasmacytoma.…”

Section: Introductionmentioning

confidence: 99%

Multiple cranial nerve palsies: As first presentation of multiple myeloma with intracranial plasmacytoma

Gurudath¹,

Singh²,

Singh³

2012

J Acad Med Sci

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of examination was all normal. Blood routine examination showed hemoglobin of 9.2 g/dl, total leucocytes count of 17,790 cells/cu mm; neutrophil was 67% and lymphocyte was 30%. Erythrocyte sediment rate was 82 mm/1 st h. No abnormal cells are seen in peripheral smear. Urine routine examination was normal and urinary Bence-Jones proteins were absent. Blood chemistry showed serum creatinine of 4.3 mg/dl, urea of 131 mg/dl, serum calcium was 15.2 mg/dl and serum phosphorus was 5.9 mg/dl. Rheumatoid factor and antinuclear antibody were negative. Cerebrospinal fluid routine examination was normal with no malignant cells. X-ray skull and X-ray chest showed multiple punched out lesions [ Figure 2a and b]. Computed tomography of the spine showed multiple punched out osteolytic lesions over the vertebral body-dorsal 6 th , 8 th , 10 th , and lumbar second [ Figure 3]. Magnetic resonance imaging (MRI) brain showed an extra axial mass at the base of the skull measuring 3.5 × 2.3 cm involving the right side of clivus, dorsum sella, sphenoid, and right cavernous sinus causing the obliteration of cavernous sinus and its contents and extending up to right cerebellopontine angle, isointense in Tl-and T2-weighted images with gadolinium-diethylenetriamine pentaacetic enhancement [ Figure 4a and b]. Bone marrow aspiration showed 58% plasma cells with a good number of binucleated forms and flame cells [ Figure 5a]. Aspiration cytology of right sterno-clavicular joint swelling showed binucleated plasma cells suggestive of plasmacytoma [ Figure 5b]. Serum electrophoresis showed presence of narrow and moderately intense band in gamma fraction suggestive of M-Spike. After reaching the diagnosis of MM with multiple plasmacytoma, patient was treated with thalidomide 200 mg/day and dexamethasone. After 1 month, patient showed improvement clinically [ Figure 6]. ABSTRACT CASE REPORTCompression of cranial nerves (CNs) by an intracranial plasmacytoma is considered to be an unusual presentation of multiple myeloma (MM). Here, we report a case of right 3 rd , 6 th , 9 th , 10 th and 12 th CN involvement, which emphasizes the fact that multiple CN palsy can be the first presenting feature of MM.

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“…The multiple cranial neuropathies in combination such as Foster Kennedy syndrome, cavernous sinus syndrome, Gradenigo syndrome and jugular foramen syndrome had been reported in late stages of MM. [6,7,8] Multiple CNs involvements as the initial presentation for plasmacytoma had been reported very rarely. [3,4,5] Ko et al reported a case of the intracranial plasmacytoma in the cavernous sinus presented as left 6th and partial 5 th CN palsy.…”

Section: Case Reportmentioning

confidence: 99%