Mononeuritis multiplex - Symptoms, Causes, Images, and Treatment Options

Diseases

Highlights & Basics

Key Highlights

Mononeuritis multiplex (MNM) consists of a heterogeneous group of peripheral nerve disorders.
MNM presents with sensory and motor deficits in the distribution of specific peripheral nerves, and may be acute, subacute, or (rarely) chronic.
MNM is most commonly caused by vasculitis, which may be either systemic or isolated to the nerves. Other causes include hypersensitivity reactions to drugs or infections, or direct viral or bacterial infection of nerves.
Diagnosis is based on clinical picture, electrophysiologic evidence of axon destruction, and characteristic changes seen on nerve biopsy.
Therapy varies with underlying MNM etiology. Most vasculitic neuropathies are treated initially with corticosteroids. Oral cyclophosphamide may also form part of first-line treatment, depending on disease severity. Intravenous cyclophosphamide and oral methotrexate are further treatment options if the response to initial treatment is insufficient.

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Definition

Epidemiology

Etiology

Pathophysiology

Images

Borderline tuberculoid leprosy showing depigmented anesthetic skin patches
Medium-size artery and arterioles in epi- perineurium of sural nerve showing transmural dense mixed cell infiltrates, fibrinoid necrosis and luminal occlusion (arrow) in a case of polyarteritis nodosa. Note that the muscularis layer is interrupted and destroyed by the inflammatory infiltrate (arrowhead). Paraffin section; Hematoxylin and Eosin

Citations

Key Articles

Graf J, Imboden J. Vasculitis and peripheral neuropathy. Curr Opin Rheumatol. 2019 Jan;31(1):40-5.[Abstract]
Beachy N, Satkowiak K, Gwathmey KG. Vasculitic neuropathies. Semin Neurol. 2019 Oct;39(5):608-19.[Abstract]
Collins MP, Hadden RD. The nonsystemic vasculitic neuropathies. Nat Rev Neurol. 2017 Apr;13(5):302-16.[Abstract][Full Text]
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].[Abstract][Full Text]

Referenced Articles

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