Abstract Details

Title Profound CNS Multiple Myeloma Carcinomatosis Causing Weakness and Vision Loss

Topic Neuro-oncology

Presentation(s) Neuro-oncology Posters (7:00 AM-5:00 PM)

Poster/Presentation
Number 027

Objective

- The viewer will appreciate the epidemiology and clinical features of Multiple Myeloma Carcinomatosis
- The viewer will appreciate a multidisciplinary approach to the diagnosis of Multiple Myeloma Carcinomatosis
- The viewer will appreciate radiologic and laboratory findings associated with Multiple Myeloma Carcinomatosis

Background Multiple Myeloma (MM) is characterized by a neoplastic proliferation of monoclonal immunoglobulin-producing plasma cells and has many clinical manifestations. Central Nervous System (CNS) involvement is a rare complication of MM, constituting less than 1% of patients. It can present as a solitary cerebral lesion, intraparenchymal infiltration, or diffuse leptomeningeal disease. Based on the heterogeneity of clinical features, CNS-MM can be difficult to recognize in clinical practice. In this report, we present a challenging case of MM carcinomatosis, striking imaging figures, a multidisciplinary approach to diagnosis, and a detailed literature review.

Design/Methods N/A

Results We present the case of a 57 year-old-male with a long standing history of multiple myeloma who presented to our emergency department complaining of a two-week history of progressive dysphagia. Neurology was consulted when the patient reported progressive left eye blindness with neck and upper extremity weakness. MRI of the orbits and brain with contrast showed enhancement of multiple cranial nerves and bilateral perioptic nerve sheaths. Lumbar puncture showed 111 nucleated cells per microliter and markedly elevated protein. Flow cytometry demonstrated a population of cells that expressed CD138, CD45, and (dim) CD56 consistent with MM involving the CNS. The diagnosis of MM carcinomatosis was made and the patient elected to transition to comfort care.

Conclusions CNS involvement is a rare complication of MM that has limited reference in the medical literature. It is a heterogeneous and challenging condition to treat, but is important to recognize given its prognostic implications. In this report, we provide a multidisciplinary approach to diagnosis, a clinically relevant literature review, and clinical pearls for providers.

Authors/Disclosures
William Hoffman, MD (United States Air Force) PRESENTER	The institution of Dr. Hoffman has received research support from United States Air Force. Dr. Hoffman has a non-compensated relationship as a Member with United States Air Force that is relevant to AAN interests or activities.
	No disclosure on file
	No disclosure on file
	No disclosure on file
	No disclosure on file
	No disclosure on file
	No disclosure on file
Jason N. Harris, MD	The institution of Dr. Harris has received research support from DOD. The institution of Dr. Harris has received research support from DOD.

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