Investig Magn Reson Imaging.  2015 Dec;19(4):252-255. 10.13104/imri.2015.19.4.252.

A Rare Case of Diffuse Pachymeningeal Involvement of Multiple Myeloma

• Yoon J
• Kim EJ
• Lee KM
• Choi WS
• Park BJ

• KMID: 2151774
• DOI: http://doi.org/10.13104/imri.2015.19.4.252

Abstract

Intracranial involvement in multiple myeloma patients takes up around 1%, and is usually known to be present in the parietal bone or skull base in cases of skull vault involvement, while it presents in the dura and parenchyma in cases of intracranial involvement. Primary pachymeningeal invasion is even rarer with extremely rapid progression and very poor prognosis. It is our intent to report a case in which we had to differentiate multiple myeloma with other metastatic tumors, lymphoma, and leukemia with intracranial involvement. Our patient showed an osteolytic lesion of the skull with dural involvement and subdural mass formations.

Keyword

Multiple myeloma

MeSH Terms

Humans
Leukemia
Lymphoma
Multiple Myeloma*
Parietal Bone
Prognosis
Skull
Skull Base

Figure

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  Fig. 1 Whole spine MR and CT images of a 53-year-old female patient. The spine MR images (a-c) show diffuse heterogeneous signal intensity of vertebral bodies on both T1WI and T2WI. Homogeneously enhancing posterior epidural masses at the level of T4-5 and T10-12 also noted on the contrast enhanced T1WI (c). The whole spine CT image shows no evidence of bony destructive changes (d).

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  Fig. 2 Non-enhanced brain CT images of the patient. Multifocal osteolytic lesions of the skull bones (a) are noted. Also, a diffuse and high attenuated subdural lesion at left fronto-parietal convexity is present (b).

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  Fig. 3 Contrast enhanced brain MR images of the patient. The subdural mass shows iso signal intensity as the cerebral cortex on T1WI (a), T2WI (b), and FLAIR images (c). Diffuse heterogeneous enhancement of the mass along the thickened dura mater is noted on contrast enhanced T1WI (d, e).

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