Hyperviscosity Syndrome Differential Diagnoses

Updated: Sep 09, 2021
  • Author: Thomas J Hemingway, MD, FACEP; Chief Editor: Barry E Brenner, MD, PhD, FACEP  more...
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Diagnostic Considerations

Underlying disorders to consider in patients with hyperviscosity syndrome include the following:

  • Multiple myeloma

  • Waldenström macroglobulinemia

  • Leukostasis (see the Medscape Reference article Oncologic Emergencies, under Hyperleukocytosis)

  • Polycythemia

  • Thrombocytosis

In patients with Waldenström macroglobulinemia, neurologic manifestations are common and are often due to hyperviscosity syndrome or immune peripheral neuropathy. Very rarely, neurologic signs and symptoms in these patients may result from lymphoproliferative infiltration of the central nervous system, a condition known as Bing-Neel syndrome. [13]

The diagnosis of Bing-Neel syndrome may be made by magnetic resonance imaging and cerebrospinal fluid analysis, which may show may show lymphocytic pleocytosis, elevated protein, and IgM kappa or lambda light chain restriction. Treatment is with cranial irradiation and/or intrathecal chemotherapy.

Differential Diagnoses