mononeuritis multiplex
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Introduction
Inflammation of several nerves generally in an unrelated anatomical distribution.
Etiology
- polyarteritis nodosa
- rheumatoid arthritis
- systemic lupus erythematosus
- mixed connective tissue disease
- Sjogren's syndrome
- Wegener's granulomatosis
- progressive systemic sclerosis
- Churg-Strauss allergic granulomatosis
- hypersensitivity angiitis
- leprosy
- sarcoidosis
- amyloidosis (certain types)
- hypereosinophilia syndrome
- cryoglobulinemia
- diabetic neuropathy (multifocal type)
- cytomegalovirus in immunocompromised hosts[3]
- HIV1 infection[3]
- Lyme disease
- lymphoma
Pathology
- 1/3 of patients have a demyelinating neuropathy
- 1/2 with ischemia generally secondary to vasculitis affecting vasa vasorum or vasa nervorum
- also occurs in systemic inflammation condidions[3]
Clinical manifestations
- involvement of multiple non-contiguous nerve trunks either partially or completely
- evolves over days to years
- as the disease process worsens, the distribution may become less patchy & more confluent & symmetric
- some patients present as distal symmetric neuropathy
- frequently painful
- may cause profound weakness
- peroneal nerve is the most commonly affected nerve[3]
Laboratory
- investigation of vasculitis
Diagnostic procedures
Management
- if the underlying disease process causing nerve ischemia can be suppressed, prognosis is good
More general terms
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
- ↑ 3.0 3.1 3.2 3.3 3.4 3.5 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