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Acta Neurologica Belgica

, Volume 112, Issue 1, pp 9–13 | Cite as

Therapeutic challenges in a patient with POEMS syndrome and recurrent stroke: presentation of a case and review of the literature

  • Björn SommerEmail author
  • Jens Schaumberg
Review Article

Abstract

POEMS syndrome includes the clinical features of polyneuropathy, organomegaly, endocrinopathy, monoclonal gammopathy and skin changes. A severe complication of patients with this syndrome is ischemic stroke, which has been described only occasionally despite the hematologic abnormalities that may be associated with the disease. In the literature, only eight patients have been reported as suffering from multiple or recurrent strokes until now. We present a 54-year-old woman from Sri Lanka with POEMS syndrome who experienced recurrent ischemic strokes followed by an acute abdomen and global heart failure. On the basis of a literature review, we discuss current therapeutic approaches and their possible side effects.

Keywords

POEMS syndrome Ischemic stroke Secondary prophylaxis Polyneuropathy Complication 

Notes

Conflict of interest

The authors declare that they have no conflict of interest relevant to this article.

References

  1. 1.
    Bardwick PA, Zvaifler NJ, Gill GN, Newman D, Greenway GD et al (1980) Plasma cell dyscrasia with polyneuropathy, organomegaly, endocrinopathy, M protein, and skin changes: the POEMS syndrome. Report on two cases and a review of the literature. Medicine (Baltimore) 59:311–322Google Scholar
  2. 2.
    Dispenzieri A, Kyle RA, Lacy MQ, Rajkumar SV, Therneau TM et al (2003) POEMS syndrome: definitions and long-term outcome. Blood 101:2496–2506PubMedCrossRefGoogle Scholar
  3. 3.
    Dispenzieri A (2007) POEMS syndrome. Blood Rev 21:285–299PubMedCrossRefGoogle Scholar
  4. 4.
    Kuwabara S, Dispenzieri A, Arimura K, Misawa S (2008) Treatment for POEMS (polyneuropathy, organomegaly, endocrinopathy, M-protein, and skin changes) syndrome. Cochrane Database Syst Rev:CD006828Google Scholar
  5. 5.
    Kang K, Chu K, Kim DE, Jeong SW, Lee JW et al (2003) POEMS syndrome associated with ischemic stroke. Arch Neurol 60:745–749PubMedCrossRefGoogle Scholar
  6. 6.
    Dupont SA, Dispenzieri A, Mauermann ML, Rabinstein AA, Brown RD Jr (2009) Cerebral infarction in POEMS syndrome: incidence, risk factors, and imaging characteristics. Neurology 73:1308–1312PubMedCrossRefGoogle Scholar
  7. 7.
    Schaumberg J, Müller-Habich C, Müller-Jensen A (2010) POEMS syndrome: difficult to diagnose, difficult to treat. Akt Neurol 37:86–88CrossRefGoogle Scholar
  8. 8.
    Forster A, Müri R (1998) Rezidivierende zerebrovaskuläre Insulte—Manifestation des POEMS-Syndroms? Schweiz Med Wochenschr 128:1059–1064PubMedGoogle Scholar
  9. 9.
    Rössler M, Kiessling B, Klotz JM, Langohr HD (2004) Recurrent cerebral ischemias due to cerebral vasculitis associated with incomplete POEMS syndrome with Castleman disease. Nervenarzt 75:790–794PubMedGoogle Scholar
  10. 10.
    Lee MR, Choi HJ, Lee EB, Baek HJ (2007) POEMS syndrome complicated by extensive arterial thromboses. Clin Rheumatol 26:1989–1992PubMedCrossRefGoogle Scholar
  11. 11.
    Garcia T, Dafer R, Hocker S, Schneck M, Barton K et al (2007) Recurrent strokes in two patients with POEMS syndrome and Castleman’s disease. J Stroke Cerebrovasc Dis 16:278–284PubMedCrossRefGoogle Scholar
  12. 12.
    Zenone T, Bastion Y, Salles G, Rieux C, Morel D et al (1996) POEMS syndrome, arterial thrombosis and thrombocythaemia. J Intern Med 240:107–109PubMedCrossRefGoogle Scholar
  13. 13.
    Lesprit P, Authier FJ, Gherardi R, Bélec L, Paris D et al (1996) Acute arterial obliteration: a new feature of the POEMS syndrome? Medicine (Baltimore) 75:226–232CrossRefGoogle Scholar
  14. 14.
    Scarlato M, Previtali SC, Carpo M, Pareyson D, Briani C et al (2005) Polyneuropathy in POEMS syndrome: role of angiogenic factors in the pathogenesis. Brain 128:1911–1920PubMedCrossRefGoogle Scholar
  15. 15.
    Kristinsson SY (2010) Thrombosis in multiple myeloma. Hematology Am Soc Hematol Educ Program 437–444Google Scholar
  16. 16.
    Ipek Y, Fehmi H, Sevgi BK, Deniz S (2011) Thrombotic complications in multiple myeloma: a report of three cases and review of the literature. J Thromb Thrombolysis. doi: 10.1007/s11239-011-0636-z Google Scholar
  17. 17.
    Geeganage C, Wilcox R, Bath PM (2010) Triple antiplatelet therapy for preventing vascular events: a systematic review and meta-analysis. BMC Med 8:36PubMedCrossRefGoogle Scholar
  18. 18.
    Balucani C, Barlinn K, Zivanovic Z, Parnetti L, Silvestrini M et al (2010) Dual antiplatelet therapy in secondary prevention of ischemic stroke: a ghost from the past or a new frontier? Stroke Res Treat. doi: 10.4061/2010/427418 Google Scholar
  19. 19.
    Kaygusuz I, Tezcan H, Cetiner M, Kocakaya O, Uzay A et al (2010) Bortezomib: a new therapeutic option for POEMS syndrome. Eur J Haematol 84:175–177PubMedCrossRefGoogle Scholar
  20. 20.
    Li J, Zhang W, Jiao L, Duan MH, Guan HZ et al (2011) Combination of melphalan and dexamethasone for patients with newly diagnosed POEMS syndrome. Blood 117:6445–6449PubMedCrossRefGoogle Scholar

Copyright information

© Belgian Neurological Society 2012

Authors and Affiliations

  1. 1.Department of NeurosurgeryUniversity of Erlangen-NürnbergErlangenGermany
  2. 2.Department of NeurologyAsklepios Klinik AltonaHamburgGermany

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