MENINGEAL AND CEREBRAL INVOLVEMENT IN MUL TIPLE-MYELOMA - 3 NEW CASESAND REVIEW OF THE LITERATURE

Neurologic manifestations are nor unusual in multiple myeloma. Convers ely meningeal and cerebral involvement have been very rarely reported. We report here on three patients with multiple myeloma and meningeal or cerebral involvement (two of them with autopsy study): one case of cerebellar involvement associated with secondary plasma cell leukemia and two cases of meningeal involvement. We reviewed the characteristic s of 20 cases of meningeal involvement with demonstration of plasma ce lls at cerebrospinal fluid analysis (18 previously reported cases and our two patients). Meningeal involvement occurs in patients with initi ally stage III multiple myeloma in 85% of cases and is associated with the occurrence of plasma cell leukemia in 20% of cases. The most freq uent neurologic signs are: confusion (60%), altered consciousness (25% ), gait disorder (25%), cranial nerve palsy (25%). Meningismus is rare ly present. Diagnosis is based on cerebrospinal fluid analysis after l umbar puncture which should be made after cranial magnetic resonance i maging. The diagnosis of intra-cranial haemorrhage and infectious meni ngitis have to be cautiously ruled out. Despite treatments (systemic a nd/or intrathecal chemotherapy, radiation therapy), prognosis is very poor mean time of survival after the occurrence of neurologic signs is about 2 months.