Newman Neil B, Puthenpura Vidya, Mischell Stephanie, Ferreira Gabriela
Department of Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ 07082, USA.
Department of Pediatrics, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ 07082, USA.
World J Oncol. 2017 Feb;8(1):15-17. doi: 10.14740/wjon1000w. Epub 2017 Feb 23.
Multiple myeloma (MM) rarely presents with a primary neurological dysfunction, and if it does it is usually due to a plasmacytoma. This is the first case to discuss hypoglossal nerve dysfunction as the first sign of MM progression secondary to severe pathophysiologic bone lysis. A PubMed-based literature search was completed on April 17, 2016 for the terms "multiple myeloma" and "hypoglossal nerve neuropathy". A 73-year-old woman with known MM who received little treatment for several years, presented secondary to dysarthria and at first was thought to have hyperviscosity syndrome. On further examination, it was found she had light chain disease and her symptoms were secondary to severe disease progression. Imaging revealed multiple lytic lesions in the skull on skeletal survey and brain MRI revealed boney lysis near the occipital condyle and clivus likely interfering with the coursing of the hypoglossal nerve. Advanced progressing MM can cause severe boney destruction which can interfere with cranial nerve canals and cause neuropathy as a presenting symptom.
多发性骨髓瘤（MM）很少以原发性神经功能障碍为首发表现，若出现这种情况通常是由于浆细胞瘤所致。本文首次探讨了舌下神经功能障碍作为MM进展的首发症状，这是由严重的病理生理性骨溶解继发引起的。2016年4月17日，通过在PubMed上检索“多发性骨髓瘤”和“舌下神经病变”进行文献回顾。一名73岁已知患有MM的女性，数年来未接受多少治疗，因构音障碍前来就诊，最初被认为患有高黏滞综合征。进一步检查发现她患有轻链病，其症状是严重疾病进展的继发表现。影像学检查显示，骨骼X线平片发现颅骨有多个溶骨性病变，脑部MRI显示枕髁和斜坡附近的骨质溶解，可能影响了舌下神经的走行。进展期MM可导致严重的骨质破坏，进而累及颅神经管并引起神经病变作为首发症状。
