UMEM Educational Pearls

Category: Hematology/Oncology

Title: Multiple Myeloma + Altered Mental Status=Hyperviscosity Syndrome

Keywords: multiple myeloma, altered mental status, hyperviscosity syndrome (PubMed Search)

Posted: 5/18/2009 by Rob Rogers, MD (Updated: 9/27/2022)
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Multiple Myeloma + Altered Mental Status=Hyperviscosity Syndrome

Although the differential diagnosis of altered mental status is quite extensive, a patient with multiple myeloma and altered mental status should prompt consideration of one important, albeit not too common, condition.....hyperviscosity syndrome.

Some important pearls:

  • This syndrome occurs when excessive amounts of protein (immunoglobulin) are secreted by myeloma (plasma) cells.
  • Excessive circulating protein leads to sludging and ischemia in lung and brain tissue, lesding to hypoxia and altered mental status, respectively.
  • You will only pick up this diagnosis by thinking about it, so multiple myeloma + altered mental status = hyperviscosity syndrome
  • Treatment is with IVF and plasmapheresis (heme onc consult)
  • And don't forget common stuff, like stroke, subdural hematomas, meningitis, etc.