13.1.2.4 Painful trigeminal neuropathy attributed to other disorder

Identification: Female patient, 68 years old, with a progressive course of facial pain and paresthesias for 10 months.

History of Present Illness: Trigeminal Symptoms: Location: Bilateral V2-V3 (right predominance)

Characteristics:

Continuous burning pain (7/10 VAS)

Lancinant paroxysms (8/10), 5-20 episodes/day

Sensory Phenomena:

Progressive "glove" hypoesthesia on the chin

Allodynia when shaving

Course:

Weight loss of 8 kg during the period

Previous bilateral carpal tunnel syndrome

Relevant History:

Dilated cardiomyopathy (EF 35%)

Nephrotic proteinuria (3.5 g/24h)

Physical/Neurological Examination: Trigeminal Assessment:

Sensory:

"Shotgun" loss on the lower lip

Hyperpathia to percussion of the mental foramen

Motor:

Mild paresis of the right masseter

Systemic Signs:

Macroglossia with dental impressions

Periorbital purpura

Symmetrical distal peripheral neuropathy

Complementary Exams: 3T Magnetic Resonance Imaging:

Diffuse thickening of the mandibular branches

No vascular compression

Subcutaneous Fat Biopsy:

Amyloid deposits (Congo red +)

Immunohistochemistry: AL type (kappa light chains)

Electroneuromyography:

Axonal sensorimotor polyneuropathy

Reduced conduction velocity in the mental nerve