Bilateral lambda light chain amyloidomas of the trigeminal ganglia, nerves and roots

We describe a patient who developed chronic bilateral trigeminal neuropathy that was found at autopsy to be due to lambda light chain amyloidosis involving the trigeminal nerves, ganglia and roots bilaterally, as well as part of the intrapontine course of the trigeminal nerve fibres. No amyloid was found elsewhere in the nervous system or systemically. Review of previous reports indicates that the clinical features of trigeminal amyloidosis are quite stereotyped, with initial trigeminal neuralgia or dysaesthesiae, and subsequent development of facial anaesthesia and weakness of muscles of mastication. The disorder is usually unilateral but may rarely, as in the present case, occur bilaterally.