Discussion: Vertigo is a common complaint in the ER setting often requiring an inpatient hospital stay for symptom management, however it is rarely the initial presenting symptom of Multiple Myeloma secondary to hyperviscosity syndrome. Hyperviscosity is related to the greatly elevated monoclonal protein levels. Accroding to a review article published in Thrombosis and Hemostasis in 2003, symptomatic hyperviscosity is only present in about 2-6% of Multiple Myeloma patients being much more common in Waldenstroms Macroglobinemia. Its hallmark features include bleeding, ocular symptoms and neurological findings which include vertigo like our patient. Most patients do not exhibit symptoms until viscosity is greater than 4 centipoises and those symptoms can be subtle until viscosity is greater than 5. Hyperviscosity is thought to cause Vertigo by peripheral vestibular involvement causing vascular obstruction in the venules. Initial therapy is directed at reducing blood viscosity by plasmapheresis and long term management is related to treating the underlying disease to reduce monoclonal protein production.
Conclusions: This case reminds hospitalists that although rare, hyperviscosity should be considered in a patient with persistent vertigo and can be the initial presenting sign in making the early diagnosis of Multiple Myeloma or other plasma cell dyscrasias if even if more classic signs and symptoms are absent.
To cite this abstract:Girardi, M . VERTIGO AND HYPERVISCOSITY: SPINNING INTO A NEW DIAGNOSIS OF MULTIPLE MYELOMA. Abstract published at Hospital Medicine 2017, May 1-4, 2017; Las Vegas, Nev. Abstract 451. Journal of Hospital Medicine. 2017; 12 (suppl 2). https://www.shmabstracts.com/abstract/vertigo-and-hyperviscosity-spinning-into-a-new-diagnosis-of-multiple-myeloma/. Accessed October 23, 2019.