DR. ROSHNI DHOLKAWALA

DR. VIRNA SHAH

Abstract

We present to you a 39 year old male who is a known case of multiple myeloma on oral steroid therapy for 3 years. He discontinued steroids against medical advice. He presented to us with sudden onset pain in the right eye and diplopia. On examination he had restriction of movements in the right eye in all gazes with proptosis of the right eye. His MRI Brain report showed a right sphenoid sinus lesion(myeloma deposit) as well as multiple skull vault lesions consistent with multiple myeloma. MRI Orbit was normal. PET CT suggested disease progression. Multiple myeloma is a plasma cell malignancy in which monoclonal plasma cells proliferate in bone marrow, resulting in an excess of M protein leading to bone destruction & hematopoietic cell line destruction. Systemic steroids is one of the mainstay of treatment for this condition. Although neurological involvement is common, leptomeningeal involvement leading to multiple cranial nerve palsies is a very rare presentation of this condition.