Monoclonal and polyclonal immunoglobulinemia, including
lymphoma, Waldenström's
macroglobulinemia and less commonly
multiple myeloma (MM), are considered as infrequent causes of
ischemic stroke. Hyperviscosity states, as well as procoagulant disturbances, both potentially treatable, have been implicated in its etiopathogenesis. The so-called "hyperviscosity syndrome" is a clinical syndrome consisting of
headache, visual, auditory and vestibular disturbances,
confusion and decreased level of consciousness, and is caused by extreme hypervolemia with a high degree of erythrocyte aggregation caused by
paraproteinemia. However, in addition to this global
cerebral ischemia syndrome, increase in blood viscosity (BV) can also be a cause of focal
ischemia. We report a case of a patient diagnosed with
IgG type MM, who suffered multiple vertebrobasilar
transient ischemic attacks and minor
ischemic strokes concurrent with a reactivation of his
hematological disease. He became completely asymptomatic after specific treatment with
dexamethasone of the
paraproteinemia associated with MM. We discuss its pathophysiology in this report.