Isolated Abducens Nerve Palsy in Multiple Myeloma With Hyperviscosity of the Serum

Hiromasa Tsuda, Noriko Doki, Kazuteru Ohashi, Morihiro Inoue, Masao Hagihara, Kozue Tanaka


A 40-year-old woman without contributory medical history was diagnosed as having IgA type multiple myeloma, based on the immunological and pathological investigation. Blood pathology demonstrated the rouleaux formation. Then, sudden onset of left-sided complete abducens nerve palsy (6NP) without pain was preceded to initiation of chemotherapy. Cranial and orbital magnetic resonance imaging, and cerebrospinal fluid examination demonstrated no abnormalities. Under chemotherapy, 6NP was resolved within 5 weeks. This is a first reported case of multiple myeloma presenting with 6NP without intracranial lesion. We speculated that 6NP might be caused by peripheral ischemia due to hyperviscosity of the serum.

J Med Cases. 2012;3(6):373-374


Cranial sixth nerve; Ophthalmoplegia; Rouleaux formation

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