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Waldenström macroglobulinemia (WM), a disorder of plasma cells, is a low-grade lymphoplasmacytic lymphoma characterized by a monoclonal population of lymphocytes that produce monoclonal pentameric immunoglobulin M (IgM). The most common ocular manifestation of WM is venous stasis retinopathy, which occurs as a result of increased plasma viscosity. Other ophthalmic findings described include a paraneoplastic progressive retinopathy, serous retinal detachment, conjunctival infiltration, corneal deposits, neovascular glaucoma, optic nerve edema, vitritis, scleritis, dry eye syndrome, and neoplastic cell infiltration of the orbit, lacrimal gland, and extraocular muscles.1 We present a 61-year-old woman with bilateral sixth nerve paresis due to CNS involvement of WM, also known as the Bing-Neel syndrome.
Case report.
A 61-year-old woman presented to the emergency department with sudden onset of left sided weakness and numbness. Her medical history was notable for WM diagnosed 10 years previously, and treated successfully with cyclophosphamide and prednisone.
Two months prior to her admission, she began to experience severe headaches followed by binocular horizontal double vision and episodes of confusion, disorientation, and visual hallucinations. She was …
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