Intracranial Involvement in Multiple Myeloma Presenting as a Cranial Nerve Palsy
Bibliographic record
Abstract
Multiple myeloma (MM) is characterized by the neoplastic proliferation of plasma cells producing a monoclonal immunoglobulin. Neurological complications in MM most frequently occur due to spinal cord compression by bony lesions, paraprotein-related neuropathy, hypercalcemia, hyperviscosity, or amyloidosis. Intracranial involvement is a rare complication of MM occurring in only 1% of patients. It can manifest as a solitary cerebral lesion, intra-parenchymal infiltration, or diffuse leptomeningeal disease. We present a case of a leptomeningeal myeloma in a 71-year-old woman with known relapsed MM presenting with a right sixth nerve palsy. Our patient was receiving spinal irradiation for a paraspinal plasmacytoma when she complained of double vision. Clinical exam revealed a right sixth nerve palsy. MRI revealed diffuse abnormal leptomeningeal thickening and enhancement typical for diffuse leptomeningeal infiltration. She was treated with whole brain irradiation and intrathecal methotrexate combined with a lenalidomide and dexamethasone chemotherapeutic regimen but unfortunately she passed away 5 weeks after onset of visual symptoms. MM involving the central nervous system (CNS) is a rare complication of MM and carries a poor prognosis with an average survival of 3 months. Due to its rarity, treatment of CNS MM is very heterogeneous. Thus case reporting is important to accumulate data on this rare presentation.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.001 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.003 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".