title: Unusual manifestation of multiple myeloma: focal affection of central nervous system in a patient with chronic lymphocytic leukaemia.
abstract: BACKGROUND
  Involvement of the central nervous system as the first manifestation of multiple myeloma is very rare.
  
  
  OBJECTIVE
  To present an unusual case of the primomanifestation of a multiple myeloma in the form of a focal affection of the central nervous system in a patient with chronic lymphocytic leukaemia.
  
  
  RESULTS
  A female patient diagnosed with chronic B-lymphocytic leukaemia with gradually increasing right-sided cerebellar symptomatology. The CT examination revealed expansion of the cranial vault with significant compression of brain structures. The tumour was extirpated and the histological examination led to a diagnosis of a plasmocytic myeloma. A thorough examination confirmed the diagnosis of multiple myeloma with significant osteolytic involvement of the skeleton. A combined chemo- and radiotherapy resulted in adjustment in the focal neurological finding, and a partial remission of the multiple myeloma was achieved.
  
  
  CONCLUSIONS
  The above presented case describes two very unusual states: the primomanifestation of a multiple myeloma in form of a focal affection of the central nervous system, and the coincidence of a multiple myeloma as the second haematological malignancy in a patient with chronic B-lymphocytic leukaemia.
authors.affiliation: Department of Internal Medicine III, University Hospital and Palacky University, Olomouc, Czech Republic. tomas.pika@seznam.cz
authors.forename: Tomas
authors.initials: T
authors.lastname: Pika
authors.forename: Jaroslav
authors.initials: J
authors.lastname: Bacovsky
authors.forename: Miroslav
authors.initials: M
authors.lastname: Vaverka
authors.forename: Jan
authors.initials: J
authors.lastname: Hrbek
authors.forename: Jaromir
authors.initials: J
authors.lastname: Hubacek
authors.forename: Dagmar
authors.initials: D
authors.lastname: Spurna
authors.forename: Vlastimil
authors.initials: V
authors.lastname: Scudla
mesh_terms: D000368:Aged; D001932:Brain Neoplasms / Q000175:diagnosis / Q000556:secondary*; D005260:Female; D006801:Humans; D015451:Leukemia, Lymphocytic, Chronic, B-Cell / Q000175:diagnosis*; D008279:Magnetic Resonance Imaging; D009101:Multiple Myeloma / Q000175:diagnosis* / Q000473:pathology; D016609:Neoplasms, Second Primary / Q000175:diagnosis*; D014057:Tomography, X-Ray Computed