Multiple myeloma presenting as isolated sixth cranial nerve palsy

Subrata Chakrabarti, Koushik Pan, Sujoy Panchadhyayee, Subrata Halder, Rajdip Chowdhury

Abstract


Multiple myeloma with isolated third nerve palsy as the presenting complaint is a rare entity. We report a case of a 30-year-old man who developed sudden onset left-sided complete abducens nerve palsy without pain. Cranial and orbital magnetic resonance imaging and cerebrospinal fluid examination demonstrated no abnormalities. He was diagnosed as having IgG type multiple myeloma, based on the immunological and pathological investigation. After instituting chemotherapy, palsy resolved within 3 weeks. Etiology is not established beyond doubt but probably palsy was caused by nerve ischemia due to hyperviscosity of the serum. 


Keywords


Multiple myeloma, Abducens nerve

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References


Na JH, Park SH, Shin SY. Multiple myeloma manifesting as a fluctuating sixth nerve palsy. Korean J Ophthalmol. 2009;23(3):232-3.

Chin KJ, Kempin S, Milman T, Finger PT. Ocular manifestations of multiple myeloma: three cases and a review of the literature. Optometry. 2011;82(4):224-30.

Fung S, Selva D, Leibovitch I, Hsuan J, Crompton J. Ophthalmic manifestations of multiple myeloma. Ophthalmol. 2005;219(1):43-8.

Higurashi M, Yagishita S, Fujitsu K, Kitsuta Y, Takemoto Y, Osano S. Plasma cell myeloma of the skull base: report of two cases. Brain Tumor Pathol. 2004;21(3):135-6.

Movsas TZ, Balcer LJ, Eggenberger ER, Hess JL, Galetta SL. Sixth nerve palsy as a presenting sign of intracranial plasmacytoma and multiple myeloma. J Neuroophthalmol. 2000;20(4):242-5.

Yaman E, Benekli M, Coskun U, Sezer K, Ozturk B, Kaya AO, Yildiz R et al. Intrasellar plasmacytoma: an unusual presentation of multiple myeloma. Acta Neurochir (Wien). 2008;150(9):921-4.

Neki NS, Sharma RK, Sharma N, Multani LS. Multiple myeloma presenting as proptosis and sixth nerve palsy. J Assoc Physicians India. 2001;49:1116-7.

Sanders SK, Kawasaki A, Purvin VA. Long-term prognosis in patients with vasculopathic sixth nerve palsy. Am J Ophthalmol. 2002;134(1):81-4.