Foster Kennedy Syndrome Produced by Myelomatous Deposits in the Skull

Morgan, William J.

doi:10.1136/bmj.1.4915.708

Cited by 3 publications

(5 citation statements)

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“…Less commonly, intracranial extramedullary plasmacytomas compress the cerebral hemispheres, inducing seizures 24. In addition, multiple cranial neuropathies associated with extramedullary plasmacytomas, such as occurred in our patient, usually present as late manifestations of the disease and carrying a worse prognosis 10 – 13. However, despite such deranged laboratory data in our patient, it was an initial presentation leading to a diagnosis of multiple myeloma.…”

Section: Discussionmentioning

confidence: 57%

“…Isolated cranial neuropathies such as optic neuropathy, oculomotor nerve palsy, trigeminal neuropathy, abducens nerve palsy, facial palsy and hypoglossal neuropathy have been reported as neurological symptoms of solitary extramedullary plasmacytomas 4 – 9. Nevertheless, cranial neuropathies such as Foster–Kennedy syndrome, cavernous sinus syndrome, Gradenigo syndrome and jugular foramen syndrome have also been reported as manifestations of late-stage MM 10 – 13. Tolosa–Hunt syndrome is an idiopathic granulomatous inflammatory disease of cavernous sinus, which usually demonstrates painful ophthalmoplegia with variable degree of ophthalmic and maxillary nerves involvement 14.…”

Section: Introductionmentioning

confidence: 99%

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Extramedullary plasmacytoma masquerading as Tolosa-Hunt syndrome: a case report

Huang²,

Liu³

2009

Case Reports

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Painful ophthalmoplegia due to extramedullary plasmacytoma is a rare initial manifestation of multiple myeloma. The present report describes a 48-year-old man who suffered an acute onset of retro-orbital pain, left abducens palsy and left facial hypoesthesia. In addition, he exhibited an elevated erythrocyte sedimentation rate and partial responsiveness to corticosteroid treatment, all of which resemble the features of Tolosa-Hunt syndrome. Imaging studies revealed a multilobulated tumour invading the left sphenoid bone and sphenoid sinus, later confirmed as a plasmacytoma at pathology. Multiple myeloma was also diagnosed by bone marrow examination. After completion of chemotherapy and radiotherapy, the patient has been free of symptoms for 10 months. Although cranial neuropathies with any combination of oculomotor, abducens, trochlear, ophthalmic and maxillary nerves may indicate a cavernous sinus lesion, neuropathies exclusive to the abducens and maxillary nerves may raise the possibility of extracavernous sinus origin. Cranial imaging is crucial in diagnosing painful ophthalmoplegia with additional minimal cranial nerve signs.

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Section: Discussionmentioning

confidence: 57%

Section: Introductionmentioning

confidence: 99%

Extramedullary plasmacytoma masquerading as Tolosa-Hunt syndrome: a case report

Huang²,

Liu³

2009

Case Reports

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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: 98%

“…[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%