Ikreet Cheema

Monoclonal gammopathy has been associated with light chain (AL) amyloid myopathy and sporadic late-onset nemaline myopathy (SLONM) [1, 2]. A third type of monoclonal gammopathy-associated myopathy (MGAM), vacuolar myopathy with monoclonal gammopathy and stiffness (VAMMGAS), was recently described [3].

Section 1 A 71-year-old right-handed male nonsmoker with type 2 diabetes, hypertension, and chronic lymphocytic leukemia (CLL) never requiring active treatment presented to the hospital with 1 week of subacute-onset nausea, vomiting, and unsteady gait. On examination, he was afebrile with blood pressure 155/82 mm Hg and heart rate 62 bpm. He had right hemiataxia with wide-based gait. CT head and CT angiogram resulted in ischemic stroke diagnosis with no vascular abnormalities.

Clinical Reasoning: A 71-year-old Male with Horizontal Gaze Palsy, Anarthria, and Quadriparesis Ikreet Cheema, Nicole Ng, Tychicus Chen Neurology Apr 2021, 10.1212/WNL.0000000000012048; DOI: 10.1212/WNL.0000000000012048