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Mononeuritis multiplex

Última revisão: 11 Aug 2025
Última atualização: 26 Sep 2023

Resumo

Definição

História e exame físico

Principais fatores diagnósticos

  • numbness
  • weakness
  • pain
  • sicca symptoms
  • parotid gland enlargement
  • rash, ulcerations, or pigment changes
  • wheeze, cough, other pulmonary signs
  • fever, night sweats, weight loss, and malaise
Detalhes completos

Outros fatores diagnósticos

  • predisposing conditions causing vasculitis, inflammation, or other nerve damage
Detalhes completos

Fatores de risco

  • age over 50 years
  • sarcoidosis
  • hepatitis C
  • cryoglobulinemia
  • hepatitis B
  • connective tissue disease
  • livedo reticularis
  • primary vasculitis
  • medications
  • HIV infection
  • non-HIV, non-hepatitis infections
  • severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection
  • recreational drug use
  • genetic predisposition
Detalhes completos

Investigações diagnósticas

Primeiras investigações a serem solicitadas

  • electromyogram (EMG)
  • CBC 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)
  • anti-double-stranded (ds) DNA
  • anti-Sjogren syndrome-related antigen A (SSA) or -SSB antibodies
  • serum angiotensin-converting enzyme
  • protein electrophoresis and immunofixation
  • chest x-ray
  • urinalysis
  • muscle and nerve biopsy
Detalhes completos

Investigações a serem consideradas

  • anti-Smith (anti-Sm) antibodies
  • anti-topoisomerase I (anti-Scl 70) and anti-centromere (ACA) antibodies
  • skin biopsy
  • lip biopsy
  • anti-Hu antibodies
  • cerebrospinal fluid (CSF) analyses
  • CT of chest, abdomen/pelvis
  • positron emission tomography (PET) scan of chest, abdomen, or pelvis
  • conventional angiography
  • magnetic resonance angiography
Detalhes completos

Algoritmo de tratamento

AGUDA

primary systemic or nonsystemic vasculitic neuropathies: initial presentation

secondary vasculitic neuropathies: initial presentation

CONTÍNUA

vasculitis in remission

Colaboradores

Autores

Ashok Verma, MD, DM, MBA, FAAN, FANA

Professor of Neurology

Director, Neuromuscular Medicine Fellowship Training Program

University of Miami Miller School of Medicine

Don Soffer Clinical Research Center

Miami

FL

Declarações

AV declares that he has no competing interests.

Agradecimentos

Professor Ashok Verma would like to gratefully acknowledge Dr Kevin Scott, Dr Milind Kothari, and Dr Jenice Robinson, the previous contributors to this topic.

Declarações

JR, KS, and MK declare that they have no competing interests.

Revisores

John J. Kelly, MD

Professor and Chairman

Department of Neurology

The George Washington University Medical Center

Washington

DC

Declarações

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

Declarações

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

Declarações

JB declares that he has no competing interests.

Peer reviewer acknowledgements

BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.

Disclosures

Peer reviewer affiliations and disclosures pertain to the time of the review.

Referências

Nossas equipes internas de editoria e de evidências trabalham em conjunto com colaboradores internacionais especializados e pares revisores para garantir que forneçamos acesso às informações o mais clinicamente relevantes possível.

Principais artigos

Graf J, Imboden J. Vasculitis and peripheral neuropathy. Curr Opin Rheumatol. 2019 Jan;31(1):40-5. Resumo

Beachy N, Satkowiak K, Gwathmey KG. Vasculitic neuropathies. Semin Neurol. 2019 Oct;39(5):608-19. Resumo

Collins MP, Hadden RD. The nonsystemic vasculitic neuropathies. Nat Rev Neurol. 2017 Apr;13(5):302-16.Texto completo  Resumo

Hellmich B, Sanchez-Alamo B, Schirmer JH, et al. EULAR recommendations for the management of ANCA-associated vasculitis: 2022 update. Ann Rheum Dis. 2023 Mar [Epub ahead of print].Texto completo  Resumo

Artigos de referência

Uma lista completa das fontes referenciadas neste tópico está disponível para os usuários com acesso total ao BMJ Best Practice.
  • Mononeuritis multiplex images
  • Diagnósticos diferenciais

    • Diabetic lumbosacral radiculoplexus neuropathy
    • Multiple compression/entrapment mononeuropathies
    • Hereditary neuropathy with liability to pressure palsies
    Mais Diagnósticos diferenciais
  • Diretrizes

    • EULAR recommendations for the management of ANCA-associated vasculitis: 2022 update
    • European Academy of Neurology/Peripheral Nerve Society guideline on diagnosis and treatment of chronic inflammatory demyelinating polyradiculoneuropathy
    Mais Diretrizes
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