Hypoglossal Nerve Mononeuropathy as the 1st presenting sympt
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Case Report
A 73-year-old female with a history of MM presented to the emergency department with progressive slurred speech due to a rightward deviated tongue for 4 days. These symptoms were not associated with vision loss or weakness. Physical exam demonstrated overt right-sided tongue deviation, with no other focal neurologic deficits. The patient endorsed a history of MM diagnosis in the past but underwent only a few chemotherapy treatments due to her religious beliefs as a Jehovah’s Witness and was generally not receiving regular medical care. Given the patient’s history of MM, a code stroke was initiated for suspected hyperviscosity syndrome as the cause of the stroke. She received a computed tomography (CT) of her head, which revealed marrow abnormalities specifically in the calvarium consistent with advanced MM, but no clear areas of ischemic or hemorrhagic strokes. The clinicians decided to further pursue a magnetic resonance angiogram (MRA) of her brain, which revealed a patent circle of Willis with no occlusions. After obtaining more collateral information, it was revealed the patient was diagnosed with MM in 2008, and was found at that time to have 20% plasma cells in her marrow. She received several cycles of chemotherapy at that time but chose not to continue therapy. In 2010, she received radiation for two plasmacytomas that formed in the epidural space but had limited follow-up or further treatment thereafter....