68-year-old presents with sudden onset hemiparesis affecting the left face, arm and leg. On examination, you note left-sided hemiparesis and left homonymous hemianopia. You also note lymphadenopathy and splenomegaly. Further investigations reveal an IgM paraprotein of 40 g/L and the skeletal survey shows no bone lesions. A blood test demonstrates:
Na+ = 38 mmol/l
K+ = 4.2 mmol/l
Ca2+ = 2.45 mmol/l
Urea = 4.4 mmol/l
Creatinine = 96 µmol/l
What is the most likely underlying cause of the stroke?
A. Myeloma
B. Waldenstrom’s Macroglobulinemia
C. Chronic Lymphocytic Leukemia
D. Infective Endocarditis Vegetative Embolism
E. Atrial Myxoma
Ans:B. Waldenstrom’s Macroglobulinemia