Bilateral sixth cranial nerve palsy as a presenting feature of multiple myeloma: A rare presentation

Abstract

Sixth cranial nerve palsy is the most common cause of acquired extraocular muscle paralysis. Neoplasm, trauma, raised intracranial pressure, and vascular disease are the most common etiologies of sixth nerve dysfunction. Multiple myeloma is a chronic, progressive, and fatal neoplastic proliferation of plasma cells and can produce tumors or plasmacytomas, and bone marrow lesions. We here present a case of a 53-year-old man who was presented with a holocranial headache and double vision. On examination, patient was found to have bilateral lateral rectus palsy. The patient was diagnosed as having IgA kappa type multiple myeloma based on immunological and pathological investigation. Contrast-enhanced computed tomography brain showed an enhancing lesion in clivus and sphenoid bone. Under chemotherapy, sixth cranial nerve palsy was resolved completely. We speculated that sixth nerve palsy might be caused by compression and stretching along the path of the sixth nerve at clivus.

Keywords

• B/L sixth nerve palsy
• clivus
• multiple myeloma