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

Abstract

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.

Corrosion mechanism of corrosion-resistant steel developed for bottom plate of cargo oil tanks

“…There are peaks at 338, 385, 412, 480, and 685 cm −1 in Raman spectra of the self-developed steel, which are typical Raman spectra of goethite α-FeOOH. The bands at 320, 560, 613 and 680 cm −1 are assigned to magnetite Fe 3 O 4 [25] . This demonstrates that corrosion product of the self-developed steel is composed of α-FeOOH and Fe 3 O 4 .…”

“…It has been declared that copper ions dissolved during corrosion reaction could be re-precipitated on the surface of steel and served as an efficient cathodic site. This mechanism is applicable when pH value of the local electrolyte is quite low; especially in the presence of chloride ions [25] . In this work, corrosion electrolyte is 10 wt.% NaCl solutions with pH value of 0.85.…”