Dr.Priya Rajasekaran, P21604
We report a rare case of 47 year old male presenting with diplopia found to have left 3rd,4th,5th,6th cranial nerve involvement on examination with no significant systemic conditions .MRI brain and orbit shows multiple destructive punched out lesions involving skull vault, sphenoidal body with involvement of left side 3rd,4th,5th,6th cranial nerve involvement ,with additional lesions in right side ramus of mandible, zygoma, right 3rd ,4th,5th,6th rib, right proximal femur and superior pubic ramus suggestive of multiple myeloma. Patient was referred to oncologist for further management. Ophthalmic involvement occurs rarely in a case of multiple myeloma and tends to occur late in the course of known disease .Multiple myeloma is usually associated with neurological features like peripheral neuropathy, compressive myelopathy or drug related neuropathy .It is unusual for multiple myeloma to present with multiple cranial nerve palsies as first sign.
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