Mononeuritis Multiplex Clinical Presentation
- Author: Divakara Kedlaya, MBBS; Chief Editor: Robert H Meier III, MD more...
History
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
Vial C, Bouhour F. [Vasculitis multiple mononeuropathies]. Rev Prat. Nov 15 2008;58(17):1896-9. [Medline].
Magy L. [What is a peripheral neuropathy?]. Rev Prat. Nov 15 2008;58(17):1873-7, 1880-1. [Medline].
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. Dec 2008;79(12):1376-81. [Medline]. [Full Text].
Pagnoux C. Churg-Strauss syndrome: evolving concepts. Discov Med. Mar 2010;9(46):243-52. [Medline].
Garzoni L, Vanoni F, Rizzi M, et al. Nervous system dysfunction in Henoch-Schonlein syndrome: systematic review of the literature. Rheumatology (Oxford). Dec 2009;48(12):1524-9. [Medline].
Makol A, Grover M. Adalimumab induced mononeuritis multiplex in a patient with refractory rheumatoid arthritis: a case report. Cases J. Oct 30 2008;1(1):287. [Medline]. [Full Text].
Greenberg MK, Sonoda T. Mononeuropathy multiplex complicating idiopathic thrombocytopenic purpura. Neurology. Sep 1991;41(9):1517-8. [Medline].
Kumar S. Painful mononeuritis multiplex in idiopathic thrombocytopenic purpura. Indian Pediatr. Jun 2005;42(6):621-2. [Medline].
Khadilkar SV, Benny R, Kasegaonkar PS. Proprioceptive loss in leprous neuropathy: a study of 19 patients. Neurol India. Oct-Dec 2008;56(4):450-5. [Medline]. [Full Text].
Lenglet T, Haroche J, Schnuriger A, et al. Mononeuropathy multiplex associated with acute parvovirus B19 infection: characteristics, treatment and outcome. J Neurol. Jul 2011;258(7):1321-6. [Medline].
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. Apr 2007;61(4):212-5. [Medline].
Peshin R, O'Gradaigh D. Mononeuritis multiplex as a presenting feature of Wegener granulomatosis: a case report. Clin Rheumatol. Aug 2007;26(8):1389-90. [Medline].
Mauermann ML, Ryan ML, Moon JS, et al. Case of mononeuritis multiplex onset with rituximab therapy for Waldenstrom's macroglobulinemia. J Neurol Sci. Sep 15 2007;260(1-2):240-3. [Medline].
Isobe N, Kira J, Kawamura N, et al. Neural damage associated with atopic diathesis: a nationwide survey in Japan. Neurology. Sep 8 2009;73(10):790-7. [Medline].
Said G, Lacroix-Ciaudo C, Fujimura H, et al. The peripheral neuropathy of necrotizing arteritis: a clinicopathological study. Ann Neurol. May 1988;23(5):461-5. [Medline].
O'Connor AB, Dworkin RH. Treatment of neuropathic pain: an overview of recent guidelines. Am J Med. Oct 2009;122(10 Suppl):S22-32. [Medline].
Finnerup NB, Sindrup SH, Jensen TS. The evidence for pharmacological treatment of neuropathic pain. Pain. Sep 2010;150(3):573-81. [Medline].

