Mononeuritis multiplex

Last reviewed: 3 Jun 2022
Last updated: 22 Oct 2019

Summary

Definition

History and exam

Key diagnostic factors

  • presence of risk factors
  • numbness
  • weakness
  • pain
  • sicca symptoms
  • parotid gland enlargement
  • rash, ulcerations, or pigment changes
  • wheeze, cough, other pulmonary signs
  • fever, weight loss, and malaise
More key diagnostic factors

Other diagnostic factors

  • predisposing conditions causing vasculitis, inflammation, or other nerve damage
Other diagnostic factors

Risk factors

  • age over 50 years
  • sarcoidosis
  • hepatitis C
  • cryoglobulinaemia
  • hepatitis B
  • connective tissue disease
  • primary vasculitis
  • drug use
  • HIV infection
  • non-HIV, non-hepatitis infections
  • recreational intravenous drug use
  • genetic predisposition
More risk factors

Diagnostic investigations

1st investigations to order

  • electromyogram (EMG)
  • FBC with differential
  • erythrocyte sedimentation rate (ESR)
  • C-reactive protein (CRP)
  • serum creatinine
  • serum glucose
  • cryoglobulins
  • serum complement
  • hepatitis B surface antigen
  • hepatitis C antibodies or RNA
  • anti-HIV antigens or HIV RNA
  • Lyme disease antibodies
  • cytoplasmic and perinuclear antineutrophil cytoplasmic antibodies (c-ANCA and p-ANCA)
  • rheumatoid factor
  • antinuclear antibodies (ANA)
  • antidouble-stranded (ds) DNA
  • anti-SSA or SSB antibodies
  • serum angiotensin-converting enzyme
  • protein electrophoresis and immunofixation
  • chest x-ray
  • urinalysis
  • muscle and nerve biopsy
More 1st investigations to order

Investigations to consider

  • anti-Smith (anti-Sm) antibodies
  • antitopoisomerase I (anti-Scl 70) and anticentromere (ACA) antibodies
  • skin biopsy
  • lip biopsy
  • anti-Hu antibodies
  • cerebrospinal fluid analyses
  • CT of chest, abdomen/pelvis
  • positron emission tomography (PET) scan of chest, abdomen, or pelvis
  • conventional angiography
  • magnetic resonance angiography
More investigations to consider

Treatment algorithm

ACUTE

hepatitis B-associated polyarteritis nodosa

hepatitis C-associated cryoglobulinaemic vasculitic neuropathy

HIV-associated vasculitic neuropathy

cancer-associated vasculitic neuropathy

classic polyarteritis nodosa or eosinophilic granulomatosis with polyangiitis (Churg-Strauss syndrome)

granulomatosis with polyangiitis (formerly known as Wegener's granulomatosis) or microscopic polyarteritis

secondary vasculitis associated with connective tissue disease

neurosarcoidosis

non-systemic vasculitic neuropathy

ONGOING

hepatitis C: remission achieved

classic polyarteritis nodosa or eosinophilic granulomatosis with polyangiitis (Churg-Strauss syndrome): remission achieved

granulomatosis with polyangiitis (formerly known as Wegener's granulomatosis) or microscopic polyarteritis: remission achieved

non-systemic vasculitic neuropathy: remission achieved

Contributors

Authors

Kevin R. Scott, MD

Clinical Neurologist

Colorado Springs Neurological Associates

Colorado Springs

CO

Disclosures

KRS declares that he has no competing interests.

Milind J. Kothari, DO

Professor of Neurology

Penn State College of Medicine

Hershey

PA

Disclosures

MJK declares that he has no competing interests.

Acknowledgements

Dr Kevin Scott and Dr Milind Kothari would like to gratefully acknowledge Dr Jenice Robinson, the previous contributor to this topic. JR declares that she has no competing interests.

Peer reviewers

John J. Kelly, MD

Professor and Chairman

Department of Neurology

The George Washington University Medical Center

Washington

DC

Disclosures

JJK declares that he has no competing interests.

Cory Toth, BSc, MD, FRCP(C)

Assistant Professor of Neurosciences

Hotchkiss Brain Institute

University of Calgary

Alberta

Canada

Disclosures

CT declares that he has no competing interests.

Jeremy Bland, FRCP

Consultant Neurophysiologist

East Kent Hospitals NHS Trust

Canterbury

Kings College Hospital NHS Trust

London

UK

Disclosures

JB declares that he has no competing interests.

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