Multiple myeloma manifesting as a fluctuating sixth nerve palsy.
We report a case of multiple myeloma that presented as a fluctuating sixth cranial nerve palsy in the absence of widespread signs of systemic disease. A 63-year-old woman presented with horizontal diplopia of two weeks duration that subjectively changed over time. Ocular examination showed a fluctuating sixth nerve palsy. A computed tomography (CT) scan of the brain showed multiple, enhancing, soft tissue, mass-like lesions involving the left cavernous sinus and the apex of both petrous bones. Based on bone marrow biopsy and hematologic findings, she was diagnosed with multiple myeloma. Multiple myeloma may be included in the differential diagnosis of a fluctuating sixth nerve palsy, and although ophthalmic signs are rare and generally occur late in the course of multiple myeloma, they can still be its first signs.
Seoul St. Mary's Hospital, Department of Ophthalmology and Visual Science, College of Medicine, The Catholic University of Korea, Seoul, Korea.
Jung Hwa
JH
Na
Shin Hae
SH
Park
Sun Young
SY
Shin
D020434:Abducens Nerve Diseases / Q000175:diagnosis / Q000209:etiology*; D001921:Brain / Q000000981:diagnostic imaging / Q000473:pathology; D003937:Diagnosis, Differential; D004172:Diplopia / Q000209:etiology; D004948:Esotropia / Q000209:etiology / Q000503:physiopathology; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D009101:Multiple Myeloma / Q000150:complications* / Q000175:diagnosis; D014057:Tomography, X-Ray Computed