Korean J Ophthalmol.  2009 Sep;23(3):232-233. 10.3341/kjo.2009.23.3.232.

Multiple Myeloma Manifesting as a Fluctuating Sixth Nerve Palsy

• Na JH
• Park SH
• Shin SY

• KMID: 1115761
• DOI: http://doi.org/10.3341/kjo.2009.23.3.232

Abstract

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.

Keyword

Fluctuating; Multiple myeloma; Sixth cranial nerve palsy

MeSH Terms

Abducens Nerve Diseases/diagnosis/*etiology
Brain/pathology/radiography
Diagnosis, Differential
Diplopia/etiology
Esotropia/etiology/physiopathology
Female
Humans
Magnetic Resonance Imaging
Middle Aged
Multiple Myeloma/*complications/diagnosis
Tomography, X-Ray Computed

Figure

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  Fig. 1 Photograph of the patient upon first examination showing her inability to abduct the left eye beyond the midline.

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  Fig. 2 Photograph of the patient one day later showing only a moderate left abduction deficit.

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  Fig. 3 Axial contrast-enhanced CT scan shows posterior bulging of the cavernous sinus with slight enhancement (arrow), suggesting a soft tissue mass within the cavernous sinus with mass effect.

Reference

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