Pathologic proliferation of the plasma cell population can produce a wide spectrum of disorders, ranging from benign solitary plasmacytoma to malignant multiple myeloma. The presentation of the resulting disease can be either localized or systemic, depending on the affected area. Multiple myeloma typically presents with systemic symptoms secondary to skeletal lytic lesions, anemia, renal failure, infection, and hyperviscosity syndrome; a diagnosis of multiple myeloma is not suspected in the absence of these features. Multiple myeloma of the skull base is very rare. We present the case of a 66-year-old man who came to us with a 2-year history of disequilibrium and who was found to have multiple myeloma with extensive involvement of the skull base.