Mononeuritis multiplex, also known as mononeuropathy multiplex, is a disorder involving two or more asymmetric peripheral nerves and is usually seen as a complication of an underlying condition 1-7. It has an acute or subacute onset and can progress to involve more nerves and develop into a polyneuropathy 3,5.
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Epidemiology
Mononeuritis multiplex is rare and most of the cases are identified after it progresses into a symmetrical polyneuropathy 1,2,5.
Diagnosis
Nerve conduction studies are performed, and nerve biopsy is often needed to confirm the diagnosis 1-3.
Clinical presentation
The patient typically presents with 1-7:
pain
loss of sensation
motor weakness
Patients present with a deep aching severe pain that is worse at night resulting in altered sleep patterns and also has patchy sensory loss and allodynia 4. The motor weakness may manifest as paralysis, wrist drop, foot drop and abnormal gait 6.
Pathology
Mononeuritis multiplex mainly has a vasculitic pathogenesis. There is occlusion of epineurial arterioles in vasa nervorum resulting in fibrinoid necrosis with neutrophilic and lymphocytic infiltrate. This also results in axonal degeneration 5.
The nerves most commonly affected are sural nerve and peroneal nerve in the lower limb and ulnar, median and radial nerves in the lower limb 5.
Etiology
Mononeuritis multiplex is commonly seen as a complication in conditions such as 1-7:
collagen vascular disorders
familial amyloidosis
Treatment and prognosis
The underlying condition needs to be managed. Intravenous immunoglobulin, steroid pulses and rituximab are often used in treatment 1.
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