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A difficult case
Multiple myeloma with multiple neurological presentations
  1. Nicholas Smith1,
  2. Katja Kimberger2,
  3. Christopher Parrish2,
  4. Stuart Currie3,
  5. Stephen Butterworth1,
  6. Jane Alty, Consultant Neurologist1
  1. 1 Department of Neurology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
  2. 2 Department of Haematology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
  3. 3 Department of Neuroradiology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
  1. Correspondence to Dr Jane Alty, Department of Neurology, Leeds Teaching Hospitals NHS Trust, Leeds LS1 3EX, UK; Jane.Alty{at}nhs.net

Abstract

Multiple myeloma is a haematological malignancy with clonal plasma cell proliferation and production of monoclonal immunoglobulins. Its neurological complications are relatively common, caused by both the disease and the treatment. Neurologists should therefore be familiar with its neurological manifestations and complications. We describe a 40-year-old woman who presented with lower cranial neuropathies mimicking variant Guillain-Barré syndrome, with normal brain and spinal cord imaging and cerebrospinal fluid (CSF) albuminocytological dissociation, and subsequently diagnosed with IgD myeloma. She relapsed repeatedly with differing neurological presentations: numb chin syndrome and twice with impaired vision, first from cerebral venous sinus thrombosis and later from leptomeningeal infiltration of the optic chiasm. We discuss the neurological complications of myeloma, emphasising the need to consider it in a wide variety of neurological presentations and repeatedly to reassess its associated neurological diagnoses. We also highlight the complexity of myeloma treatment.

  • igd myeloma
  • lower cranial neuropathies
  • numb chin syndrome
  • jehovah's witness
  • visual loss

https://doi.org/10.1136/practneurol-2019-002205

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    Footnotes

    • Contributors NS: foundation year doctor involved in patient care, data collection, literature search and assisted in writing report. JA: consultant neurologist responsible for patients’ care, author of neurological section and obtained consent. CP: consultant haematologist involved in patients’ care and coauthor of haematology section. KK: haematology registrar and coauthor of haematology section. SB: consultant neurologist involved in patients’ care and coauthor of neurological section. SC: consultant neuroradiologist, involved in patients’ care, interpreting imaging, provided images and wrote figure legends.

    • Funding This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Patient consent for publication Obtained.

    • Ethics approval Verbal approval to publish this case report was gained from the patient while she was alive. Written consent to publish was gained from the patient's next of kin.

    • Provenance and peer review Not commissioned; externally reviewed by Fiona McKevitt, Sheffield, UK and Alberto Rocci, Manchester, UK.

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