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November 7, 1977

Oculomotor Palsy as Initial Manifestation of Myeloma

JAMA. 1977;238(19):2052-2053. doi:10.1001/jama.1977.03280200064023

OF THE various tumors that may cause third nerve palsy, the most common are metastatic deposits at the base of the skull, parasellar meningiomas, chromophobe adenomas, clival chordomas, and nasopharyngeal carcinomas.1 Since plasmacytomas and multiple myelomas presenting initially with third nerve palsy have not, to our knowledge, been reported before, we present a case of plasmacytoma of the sphenoid sinus.

Report of a Case  A 57-year-old man noticed the sudden onset of horizontal diplopia that worsened over the next two days. This was followed by progressive drooping of the left eyelid, dull bifrontal headaches, and left retroorbital pain. Numbness over the forehead and left cheek were then noted.Initial physical examination showed no abnormal findings. Notable neurologic findings were limited to the cranial nerves. There was an exotropia of the left eye in the primary position of gaze, and diplopia most severe on horizontal gaze to the right. Some