This report emphasizes the cranial nerve involvement in multifocal motor neuropathy (MMN). A 68-year old woman had progressive dysphagia, proximal muscle weakness, dysphonia, dysarthria, weak tongue and weak gag reflex, and decreased muscle power on shoulders and hips. Nerve conduction studies showed conduction block in some motor nerves on proximal stimulation. There was no sensory involvement. MMN is a rare immune-mediated demyelinating neuropathy. There is motor conduction block with amplitude reduction or absence of compound muscle action potential (CMAP) obtained on proximal stimulation. Cranial nerve involvement is not the usual primary manifestation of MMN, and it can be limited to the hypoglossal nerve or rarely to oculomotor. In our case there were bulbar symptoms with dysphagia, dysarthria and tongue weakness. Many studies excluded myasthenia gravis, Lambert–Eaton syndrome and Amyotrophic lateral sclerosis (ALS). The patient responded well to intravenous immune globulin administration. We are reporting a rare case of multifocal motor neuropathy that had as initial symptoms involvement of lower cranial nerves.