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mononeuritis multiplex
Inflammation of several nerves generally in an unrelated anatomical distribution.
Etiology:
1) polyarteritis nodosa
2) rheumatoid arthritis
3) systemic lupus erythematosus
4) mixed connective tissue disease
5) Sjogren's syndrome
6) Wegener's granulomatosis
7) progressive systemic sclerosis
8) Churg-Strauss allergic granulomatosis
9) hypersensitivity angiitis
10) leprosy
11) sarcoidosis
12) amyloidosis (certain types)
13) hypereosinophilia syndrome
14) cryoglobulinemia
15) diabetic neuropathy (multifocal type)
16) cytomegalovirus in immunocompromised hosts [3]
17) HIV1 infection [3]
18) Lyme disease
19) lymphoma
Pathology:
1) 1/3 of patients have a demyelinating neuropathy
2) 1/2 with ischemia generally secondary to vasculitis affecting vasa vasorum or vasa nervorum
3) also occurs in systemic inflammation condidions [3]
Clinical manifestations:
1) involvement of multiple non-contiguous nerve trunks either partially or completely
2) evolves over days to years
3) as the disease process worsens, the distribution may become less patchy & more confluent & symmetric
4) some patients present as distal symmetric neuropathy
5) frequently painful
6) may cause profound weakness
7) peroneal nerve is the most commonly affected nerve [3]
Laboratory:
- investigation of vasculitis
a) erythrocyte sedimentation rate
b) C-reactive protein
c) rheumatoid factor
d) anti-nuclear antibody (ANA)
e) anti-neutrophil cytoplasmic antibody (ANCA)
Special laboratory:
1) nerve conduction studies
2) electromyography [3]
3) nerve biopsy
Management:
- if the underlying disease process causing nerve ischemia can be suppressed, prognosis is good
General
peripheral nerve disease; peripheral neuropathy
References
- Stedman's Medical Dictionary 26th ed, Williams &
Wilkins, Baltimore, 1995
- Harrison's Principles of Internal Medicine, 13th ed.
Isselbacher et al (eds), McGraw-Hill Inc. NY,
1994, pg 2052-55
- Medical Knowledge Self Assessment Program (MKSAP) 11, 17
American College of Physicians, Philadelphia 1998, 2015
- Medical Knowledge Self Assessment Program (MKSAP) 19
Board Basics. An Enhancement to MKSAP19.
American College of Physicians, Philadelphia 2022