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Clinical Pathologic Conference
April 2017

A Woman in Her 40s With Headache and New-Onset Seizures

Author Affiliations
  • 1Department of Neurology, Brigham and Women’s Hospital, Boston, Massachusetts
  • 2Department of Hematology, Boston Medical Center, Boston, Massachusetts
  • 3Division of Neuropathology, Department of Pathology, Brigham and Women’s Hospital, Boston, Massachusetts
  • 4Department of Pathology, Division of Hematopathology, Brigham and Women’s Hospital, Boston, Massachusetts
JAMA Neurol. 2017;74(4):476-480. doi:10.1001/jamaneurol.2016.2961

A woman in her 40s with a history of plasma cell leukemia presented with 1 month of intermittent headaches followed by a seizure. Results from laboratory studies were notable for a cerebrospinal fluid opening pressure of 28 mm H2O and 8 white blood cells, including 1 atypical plasma cell. Imaging studies revealed confluent bifrontal white matter fluid-attenuated inversion recovery hyperintensities, as well as a contrast-enhancing sellar lesion. The patient underwent a stereotactic biopsy. The differential diagnosis, pathologic findings, and diagnosis are discussed.

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