R H Paul1, A L Piatt, W M Whelihan, P F Malloy. 1. Department of Psychiatry and Human Behavior, Brown University School of Medicine, Providence, Rhode Island, USA. Robert_Paul@brown.edu
Abstract
OBJECTIVE: The goal of this investigation was to describe the neuropsychological and magnetic resonance imaging (MRI) findings in a patient with an extramedullary plasmacytoma that extensively infiltrated the cerebral dura, especially over the frontal region. BACKGROUND: Extramedullary plasmacytomas are rare tumors that have been reported to involve the dura matter in only a small number of cases. In most of the reported occurrences, the dura plasmacytomas were successfully treated with a combination of surgery and irradiation, without prominent cognitive sequelae. METHOD: MRI of the brain and neuropsychological tests were conducted approximately 13 months after the patient underwent radiotherapy. In addition, measures of frontal lobe personality characteristics were obtained before and after radiotherapy. RESULTS: MRI findings revealed extensive enhancement around the anterior frontal lobes and prominent involvement of the anterior longitudinal fissure. Results from neuropsychological testing indicated mild to moderately impaired performance on tests of working memory, complex attention, and cognitive flexibility. Further, the patient reported experiencing personality changes consistent with frontal lobe dysfunction as part of the initial symptoms of the disease, which remained unchanged after treatment. CONCLUSIONS: Our findings are the first to describe cognitive sequelae of dural plasmacytomas. In addition, results from this case study reveal that plasmacytomas of the frontal dura produce personality changes similar to those observed in patients with significant frontal lobe injury. Finally, plasmacytomas that significantly infiltrate the frontal lobes may be insensitive to radiotherapy and result in residual cognitive and personality abnormalities.
OBJECTIVE: The goal of this investigation was to describe the neuropsychological and magnetic resonance imaging (MRI) findings in a patient with an extramedullary plasmacytoma that extensively infiltrated the cerebral dura, especially over the frontal region. BACKGROUND: Extramedullary plasmacytomas are rare tumors that have been reported to involve the dura matter in only a small number of cases. In most of the reported occurrences, the dura plasmacytomas were successfully treated with a combination of surgery and irradiation, without prominent cognitive sequelae. METHOD: MRI of the brain and neuropsychological tests were conducted approximately 13 months after the patient underwent radiotherapy. In addition, measures of frontal lobe personality characteristics were obtained before and after radiotherapy. RESULTS: MRI findings revealed extensive enhancement around the anterior frontal lobes and prominent involvement of the anterior longitudinal fissure. Results from neuropsychological testing indicated mild to moderately impaired performance on tests of working memory, complex attention, and cognitive flexibility. Further, the patient reported experiencing personality changes consistent with frontal lobe dysfunction as part of the initial symptoms of the disease, which remained unchanged after treatment. CONCLUSIONS: Our findings are the first to describe cognitive sequelae of dural plasmacytomas. In addition, results from this case study reveal that plasmacytomas of the frontal dura produce personality changes similar to those observed in patients with significant frontal lobe injury. Finally, plasmacytomas that significantly infiltrate the frontal lobes may be insensitive to radiotherapy and result in residual cognitive and personality abnormalities.