Intracranial extension and spontaneous hemorrhage of a sphenoid plasmacytoma

A 71-year-old woman with IgG multiple myeloma presented initially with a compression fracture of the thoracic spine. She responded to radiation therapy and chemotherapy with melphalan and prednisone. One year later, she died from a plasmacytoma eroding intracranially from the greater wing of the sphenoid bone with an associated subdural hematoma. Uncal herniation had been preceded for several weeks by facial numbness. Cranial and intracranial plasmacytomas may occur as isolated lesions or as part of multiple myeloma and can present clinically in a variety of ways, most frequently with cranial nerve palsies. Large intracranial extensions may produce cerebral compression and spontaneous hemorrhage similar to that seen with other malignant intracranial neoplasms. The differential diagnosis of changes in level of consciousness in myeloma patients should include increased intracranial extension and spontaneous hemorrhage.