Abstrato

Multiple myeloma masquerading as abducens palsy: A case report.

Gayle E LePosa, M Adelita Vizcaino, Praveena Gupta

Purpose: To report a case of abducens palsy as the presenting symptom of multiple myeloma Case report: A 68-year-old woman with a history of systemic hypertension presented complaining of constant horizontal diplopia in left gaze for six weeks. Her entering acuities were 20/25 in the right eye and 20/20 in the left eye. Extraocular muscle testing revealed left sixth nerve palsy without any misalignment in primary gaze. The remainder of her ophthalmic examination, including other neurological testing such as cranial nerve testing, pupils, and confrontation fields, was unremarkable. MRI of the brain and orbits indicated numerous osseous lesions throughout the skull with a high-risk lesion invading the left cavernous sinus and encasing both the left internal carotid artery and the left optic nerve. After receiving these results, she was referred urgently for further imaging, which revealed additional lesions throughout her axial and appendicular skeleton, including other high risk lesions in the thoracic spine and the pelvis. Further workup confirmed the diagnosis of multiple myeloma. Conclusions: Ophthalmic findings related to multiple myeloma are generally rare and tend to occur late in the course of known disease. In this case, ipsilateral isolated sixth nerve palsy was the presenting sign of multiple myeloma in a patient. Although neurological etiology is not common with sixth nerve palsies, neurological workup including imaging should be considered routinely in patients who present with isolated sixth nerve palsy, particularly when vasculopathic risk factors are not suggested by patient history.