Medscape is available in 5 Language Editions – Choose your Edition here.


Mononeuritis Multiplex Clinical Presentation

  • Author: Divakara Kedlaya, MBBS; Chief Editor: Dean H Hommer, MD  more...
Updated: May 31, 2016


A detailed and complete medical history is vitally important in determining the possible underlying cause of mononeuritis multiplex. Pain often begins in the low back or hip and spreads to the thigh and knee on one side. The pain usually is characterized as deep and aching, with superimposed lancinating jabs that are most severe at night. Individuals with diabetes typically present with acute onset of severe, unilateral thigh pain that is followed rapidly by weakness and atrophy of the anterior thigh muscles and loss of the knee reflex. Other possible symptoms that may be reported by the patient include the following:

  • Numbness
  • Tingling
  • Abnormal sensation
  • Burning pain - Dysesthesia
  • Difficulty moving a body part - Paralysis
  • Lack of controlled movement of a body part

Physical Examination

Loss of sensation and movement may be associated with dysfunction of specific nerves. Examination reveals preservation of reflexes and good strength except in regions that have been more profoundly affected. Some common findings of mononeuritis multiplex are as follows (not listed in order of frequency):

  • Sciatic nerve dysfunction
  • Femoral nerve dysfunction
  • Common peroneal nerve dysfunction
  • Axillary nerve dysfunction
  • Radial nerve dysfunction
  • Median nerve dysfunction
  • Ulnar nerve dysfunction
  • Peroneal nerve palsy
  • Autonomic dysfunction - Dysfunction in the part of the nervous system that controls involuntary bodily functions, such as the glands, blood vessels, and heart
Contributor Information and Disclosures

Divakara Kedlaya, MBBS Clinical Associate Professor, Department of Physical Medicine and Rehabilitation, Loma Linda University School of Medicine; Medical Director, Physical Medicine and Rehabilitation and Pain Management, St Mary Corwin Medical Center

Divakara Kedlaya, MBBS is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation, Colorado Medical Society, American Association of Neuromuscular and Electrodiagnostic Medicine

Disclosure: Nothing to disclose.

Chief Editor

Dean H Hommer, MD Chief, Department of Pain Management, Brooke Army Medical Center

Dean H Hommer, MD is a member of the following medical societies: American Academy of Medical Acupuncture, American Academy of Pain Medicine, American Academy of Physical Medicine and Rehabilitation, American Association of Neuromuscular and Electrodiagnostic Medicine, American College of Healthcare Executives, American College of Sports Medicine, American Institute of Ultrasound in Medicine, American Society of Interventional Pain Physicians, American Society of Regional Anesthesia and Pain Medicine

Disclosure: Nothing to disclose.


Paul V Brooks, MD Medical Director, Department of Physical Medicine and Rehabilitation, Lexington Clinic, PSC; Assistant Professor, Department of Orthopedics, Division of Sports Medicine, Assistant Professor, Department of Surgery, University of Kentucky College of Medicine

Paul V Brooks, MD is a member of the following medical societies: American Academy of Pain Medicine, American Academy of Physical Medicine and Rehabilitation, American Association of Neuromuscular and Electrodiagnostic Medicine, American Association of University Professors, American College of Sports Medicine, American Medical Association, American Pain Society, American Spinal Injury Association, Association for Academic Psychiatry, and Brain Injury Association of America

Disclosure: Nothing to disclose.

  1. Kelkar P, Parry GJ. Mononeuritis multiplex in diabetes mellitus: evidence for underlying immune pathogenesis. J Neurol Neurosurg Psychiatry. 2003 Jun. 74(6):803-6. [Medline]. [Full Text].

  2. Ryan MM, Tilton A, De Girolami U, Darras BT, Jones HR Jr. Paediatric mononeuritis multiplex: a report of three cases and review of the literature. Neuromuscul Disord. 2003 Nov. 13(9):751-6. [Medline].

  3. Parry GJ. Mononeuropathy multiplex (AAEE case report #11). Muscle Nerve. 1985 Jul-Aug. 8(6):493-8. [Medline].

  4. Bennett DL, Groves M, Blake J, et al. The use of nerve and muscle biopsy in the diagnosis of vasculitis: a 5 year retrospective study. J Neurol Neurosurg Psychiatry. 2008 Dec. 79(12):1376-81. [Medline]. [Full Text].

  5. Gorson KC. Vasculitic neuropathies: an update. Neurologist. 2007 Jan. 13(1):12-9. [Medline].

  6. Garzoni L, Vanoni F, Rizzi M, et al. Nervous system dysfunction in Henoch-Schonlein syndrome: systematic review of the literature. Rheumatology (Oxford). 2009 Dec. 48(12):1524-9. [Medline].

  7. Finsterer J. Systemic and non-systemic vasculitis affecting the peripheral nerves. Acta Neurol Belg. 2009 Jun. 109(2):100-13. [Medline].

  8. Tracy JA, Dyck PJ, Dyck PJ. Primary amyloidosis presenting as upper limb multiple mononeuropathies. Muscle Nerve. 2010 May. 41(5):710-5. [Medline]. [Full Text].

  9. Le Clech L, Rizcallah MJ, Alavi Z, Hutin P. Mononeuritis multiplex in a patient with B-cell prolymphocytic leukaemia: a diagnostic challenge. BMJ Case Rep. 2013 Sep 2. 2013:[Medline].

  10. Tomita M, Koike H, Kawagashira Y, Iijima M, Adachi H, Taguchi J, et al. Clinicopathological features of neuropathy associated with lymphoma. Brain. 2013 Aug. 136:2563-78. [Medline].

  11. Yamamoto T, Matsuda J, Kadoya H, Mori D, Ito D, Namba T, et al. A case of MPO-ANCA-positive polyarteritis nodosa complicated by exudative otitis media, mononeuritis multiplex, and acute renal failure. Clin Exp Nephrol. 2011 Oct. 15(5):754-60. [Medline].

  12. Makol A, Grover M. Adalimumab induced mononeuritis multiplex in a patient with refractory rheumatoid arthritis: a case report. Cases J. 2008 Oct 30. 1(1):287. [Medline]. [Full Text].

  13. Agarwal V, Singh R, Wiclaf, Chauhan S, Tahlan A, Ahuja CK, et al. A clinical, electrophysiological, and pathological study of neuropathy in rheumatoid arthritis. Clin Rheumatol. 2008 Jul. 27(7):841-4. [Medline].

  14. Florica B, Aghdassi E, Su J, Gladman DD, Urowitz MB, Fortin PR. Peripheral neuropathy in patients with systemic lupus erythematosus. Semin Arthritis Rheum. 2011 Oct. 41(2):203-11. [Medline].

  15. Bhowmik A, Banerjee P. Mononeuritis multiplex complicating systemic lupus erythematosus. Indian Pediatr. 2012 Jul. 49(7):581-2. [Medline].

  16. Martin AC, Friedlander M, Kiernan MC. Paraneoplastic mononeuritis multiplex in non-small-cell lung carcinoma. J Clin Neurosci. 2006 Jun. 13(5):595-8. [Medline].

  17. Leypoldt F, Friese MA, Böhm J, Bäumer T. Multiple enlarged nerves on neurosonography: an unusual paraneoplastic case. Muscle Nerve. 2011 May. 43(5):756-8. [Medline].

  18. Elamin M, Alderazi Y, Mullins G, Farrell MA, O'Connell S, Counihan TJ. Perineuritis in acute lyme neuroborreliosis. Muscle Nerve. 2009 Jun. 39(6):851-4. [Medline].

  19. Khadilkar SV, Benny R, Kasegaonkar PS. Proprioceptive loss in leprous neuropathy: a study of 19 patients. Neurol India. 2008 Oct-Dec. 56(4):450-5. [Medline]. [Full Text].

  20. Huda S, Krishnan A. An unusual cause of mononeuritis multiplex. Pract Neurol. 2013 Feb. 13(1):39-41. [Medline].

  21. Safadi R, Ben-Hur T, Shouval D. Mononeuritis multiplex: a rare complication of acute hepatitis A. Liver. 1996 Aug. 16(4):288-9. [Medline].

  22. Verma R, Lalla R, Babu S. Mononeuritis multiplex and painful ulcers as the initial manifestation of hepatitis B infection. BMJ Case Rep. 2013 May 2. 2013:[Medline].

  23. Santoro L, Manganelli F, Briani C, Giannini F, Benedetti L, Vitelli E, et al. Prevalence and characteristics of peripheral neuropathy in hepatitis C virus population. J Neurol Neurosurg Psychiatry. 2006 May. 77(5):626-9. [Medline]. [Full Text].

  24. Lenglet T, Haroche J, Schnuriger A, et al. Mononeuropathy multiplex associated with acute parvovirus B19 infection: characteristics, treatment and outcome. J Neurol. 2011 Jul. 258(7):1321-6. [Medline].

  25. Pai B S, Pai K. Livedoid Vasculopathy and Mononeuritis Multiplex, with a Fulminant Hepatic Failure which was caused by Herpes Simplex Hepatitis: A Case Report. J Clin Diagn Res. 2013 May. 7(5):921-3. [Medline]. [Full Text].

  26. Gabbai AA, Castelo A, Oliveira AS. HIV peripheral neuropathy. Handb Clin Neurol. 2013. 115:515-29. [Medline].

  27. Modi M, Vats AK, Prabhakar S, Singla V, Mishra S. Acro-osteolysis and mononeuritis multiplex as a presenting symptom of systemic angiitis of Wegener's type. Indian J Med Sci. 2007 Apr. 61(4):212-5. [Medline].

  28. Peshin R, O'Gradaigh D. Mononeuritis multiplex as a presenting feature of Wegener granulomatosis: a case report. Clin Rheumatol. 2007 Aug. 26(8):1389-90. [Medline].

  29. Campbell SB, Hawley CM, Staples C. Mononeuritis multiplex complicating Henoch-Schonlein purpura. Aust N Z J Med. 1994 Oct. 24(5):580. [Medline].

  30. Mori K, Iijima M, Koike H, Hattori N, Tanaka F, Watanabe H, et al. The wide spectrum of clinical manifestations in Sjögren's syndrome-associated neuropathy. Brain. 2005 Nov. 128:2518-34. [Medline].

  31. Pavlakis PP, Alexopoulos H, Kosmidis ML, Mamali I, Moutsopoulos HM, Tzioufas AG, et al. Peripheral neuropathies in Sjögren's syndrome: a critical update on clinical features and pathogenetic mechanisms. J Autoimmun. 2012 Aug. 39(1-2):27-33. [Medline].

  32. Takeuchi A, Kodama M, Takatsu M, Hashimoto T, Miyashita H. Mononeuritis multiplex in incomplete Behçet's disease: a case report and the review of the literature. Clin Rheumatol. 1989 Sep. 8(3):375-80. [Medline].

  33. Walker LJ, Swallow MW, Mirakhur M. Behçet's disease presenting with mononeuritis multiplex [corrected]. Ulster Med J. 1990 Oct. 59(2):206-10. [Medline]. [Full Text].

  34. Caselli RJ, Daube JR, Hunder GG, Whisnant JP. Peripheral neuropathic syndromes in giant cell (temporal) arteritis. Neurology. 1988 May. 38(5):685-9. [Medline].

  35. Lee P, Bruni J, Sukenik S. Neurological manifestations in systemic sclerosis (scleroderma). J Rheumatol. 1984 Aug. 11(4):480-3. [Medline].

  36. Mattie R, Irwin RW. Neurosarcoidosis Presenting as Mononeuritis Multiplex. Am J Phys Med Rehabil. 2013 Nov 5. [Medline].

  37. Garg S, Wright A, Reichwein R, Boyer P, Towfighi J, Kothari MJ. Mononeuritis multiplex secondary to sarcoidosis. Clin Neurol Neurosurg. 2005 Feb. 107(2):140-3. [Medline].

  38. Thawani SP, Brannagan TH 3rd, Lebwohl B, Green PH, Ludvigsson JF. Risk of Neuropathy Among 28,232 Patients With Biopsy-Verified Celiac Disease. JAMA Neurol. 2015 Jul. 72 (7):806-11. [Medline].

  39. Al-Shekhlee A, Katirji B. Sensory Mononeuropathy Multiplex in Chronic Graft versus Host Disease. J Clin Neuromuscul Dis. 2001 Jun. 2(4):184-6. [Medline].

  40. Grisold W, Piza-Katzer H, Jahn R, Herczeg E. Intraneural nerve metastasis with multiple mononeuropathies. J Peripher Nerv Syst. 2000 Sep. 5(3):163-7. [Medline].

  41. Wolf J, Bergner R, Mutallib S, Buggle F, Grau AJ. Neurologic complications of Churg-Strauss syndrome--a prospective monocentric study. Eur J Neurol. 2010 Apr. 17(4):582-8. [Medline].

  42. Hattori N, Ichimura M, Nagamatsu M, Li M, Yamamoto K, Kumazawa K, et al. Clinicopathological features of Churg-Strauss syndrome-associated neuropathy. Brain. 1999 Mar. 122 ( Pt 3):427-39. [Medline].

  43. Gemignani F, Brindani F, Alfieri S, Giuberti T, Allegri I, Ferrari C, et al. Clinical spectrum of cryoglobulinaemic neuropathy. J Neurol Neurosurg Psychiatry. 2005 Oct. 76(10):1410-4. [Medline]. [Full Text].

  44. Titlic M, Kodzoman K, Loncar D. Neurologic manifestations of hypereosinophilic syndrome--review of the literature. Acta Clin Croat. 2012 Mar. 51(1):65-9. [Medline].

  45. Isobe N, Kira J, Kawamura N, et al. Neural damage associated with atopic diathesis: a nationwide survey in Japan. Neurology. 2009 Sep 8. 73(10):790-7. [Medline].

  46. Greenberg MK, Sonoda T. Mononeuropathy multiplex complicating idiopathic thrombocytopenic purpura. Neurology. 1991 Sep. 41(9):1517-8. [Medline].

  47. Kumar S. Painful mononeuritis multiplex in idiopathic thrombocytopenic purpura. Indian Pediatr. 2005 Jun. 42(6):621-2. [Medline].

  48. Stafford CR, Bogdanoff BM, Green L, Spector HB. Mononeuropathy multiplex as a complication of amphetamine angiitis. Neurology. 1975 Jun. 25(6):570-2. [Medline].

  49. Burns TM, Shneker BF, Juel VC. Gasoline sniffing multifocal neuropathy. Pediatr Neurol. 2001 Nov. 25(5):419-21. [Medline].

  50. Sinha S, Mahadevan A, Lokesh L, Ashraf V, Chandrasekhar Sagar BK, Taly AB, et al. Tangier disease--a diagnostic challenge in countries endemic for leprosy. J Neurol Neurosurg Psychiatry. 2004 Feb. 75(2):301-4. [Medline]. [Full Text].

  51. Pollock M, Nukada H, Frith RW, Simcock JP, Allpress S. Peripheral neuropathy in Tangier disease. Brain. 1983 Dec. 106 ( Pt 4):911-28. [Medline].

  52. Mauermann ML, Ryan ML, Moon JS, et al. Case of mononeuritis multiplex onset with rituximab therapy for Waldenstrom's macroglobulinemia. J Neurol Sci. 2007 Sep 15. 260(1-2):240-3. [Medline].

  53. Said G, Lacroix-Ciaudo C, Fujimura H, et al. The peripheral neuropathy of necrotizing arteritis: a clinicopathological study. Ann Neurol. 1988 May. 23(5):461-5. [Medline].

  54. de Luna G, Chauveau D, Aniort J, et al. Plasma exchanges for the treatment of severe systemic necrotizing vasculitides in clinical daily practice: Data from the French Vasculitis Study Group. J Autoimmun. 2015 Dec. 65:49-55. [Medline].

  55. Samson M, Puéchal X, Devilliers H, et al. Mononeuritis multiplex predicts the need for immunosuppressive or immunomodulatory drugs for EGPA, PAN and MPA patients without poor-prognosis factors. Autoimmun Rev. 2014 Sep. 13(9):945-53. [Medline].

  56. O'Connor AB, Dworkin RH. Treatment of neuropathic pain: an overview of recent guidelines. Am J Med. 2009 Oct. 122(10 Suppl):S22-32. [Medline].

  57. Finnerup NB, Sindrup SH, Jensen TS. The evidence for pharmacological treatment of neuropathic pain. Pain. 2010 Sep. 150(3):573-81. [Medline].

All material on this website is protected by copyright, Copyright © 1994-2016 by WebMD LLC. This website also contains material copyrighted by 3rd parties.