Isolated Hypoglossal Nerve Palsy Secondary to Oligosecretory Multiple Myeloma

Bahaar K Muhar; Shawn Cho; Ashwin S Sidhu; Jason Chang; Forshing Lui

doi:10.7759/cureus.33361

Isolated Hypoglossal Nerve Palsy Secondary to Oligosecretory Multiple Myeloma

Cureus. 2023 Jan 4;15(1):e33361. doi: 10.7759/cureus.33361. eCollection 2023 Jan.

Authors

Bahaar K Muhar¹, Shawn Cho¹, Ashwin S Sidhu¹, Jason Chang², Forshing Lui³

Affiliations

¹ Neurology, California Northstate University College of Medicine, Elk Grove, USA.
² Neurology, Kaiser Permanente South Sacramento Medical Center, Sacramento, USA.
³ Clinical Sciences, California Northstate University College of Medicine, Elk Grove, USA.

Abstract

Isolated hypoglossal nerve (CN XII) palsy is rare. Neurological complications of multiple myeloma (MM) are quite common, most often due to hyperviscosity and paraprotein-related neuropathy. Direct compression of CN XII can be caused by plasmacytoma, yet direct invasion by MM is extremely rare. We are reporting a very unusual case of a 45-year-old man who presented with an isolated right CN XII palsy. The cause revealed by MRI is stenosis of the hypoglossal canal resulting from lytic bony erosion. Despite negative serum and urine protein electrophoresis tests, the final diagnosis of oligosecretory MM was confirmed by serum-free light chain test and bone marrow biopsy. The causes and diagnosis of isolated XII nerve palsy and oligosecretory MM are discussed.

Keywords: free light chains; hypoglossal nerve; lytic bone lesion; multiple myeloma; oligosecretory.

Publication types

Case Reports