eMedicine Specialties > Physical Medicine and Rehabilitation > Peripheral Neuropathy

Mononeuritis Multiplex

Author: Paul V Brooks, MD, Medical Director, Department of Physical Medicine and Rehabilitation, Lexington Clinic; Assistant Professor, Department of Physical Medicine and Rehabilitation, Departments of Ortho, Lexington Clinic
Contributor Information and Disclosures

Updated: Mar 23, 2009

Introduction

Background

Mononeuritis multiplex is a painful asymmetric asynchronous sensory and motor peripheral neuropathy involving isolated damage to at least 2 separate nerve areas. Multiple nerves in random areas of the body can be affected. As the condition worsens, it becomes less multifocal and more symmetric. Mononeuropathy multiplex syndromes can be distributed bilaterally, distally, and proximally throughout the body.1,2

Mononeuritis multiplex actually is a group of disorders, not a true distinct disease entity. Typically, the condition is associated with (but not limited to) systemic disorders such as diabetes, vasculitis, amyloidosis, direct tumor involvement, polyarteritis nodosa, rheumatoid arthritis,3 systemic lupus erythematosus, and paraneoplastic syndromes. Mononeuritis multiplex also may be associated with Lyme disease, Wegener's granulomatosis, Sjögren syndrome, cryoglobulinemia, hypereosinophilia, temporal arteritis, scleroderma, sarcoidosis, leprosy,4 acute viral hepatitis A, and acquired immunodeficiency syndrome (AIDS).5,6

Pathophysiology

Mononeuritis multiplex involves damage to at least 2 separate nerve areas. This condition can become progressively worse over time. The damage to the nerves involves destruction of the axon (ie, the part of the nerve cell that is analogous to the copper part of a wire), thus interfering with nerve conduction. Common causes of damage include a lack of oxygen from decreased blood flow or inflammation of blood vessels. Approximately 33% of cases originate from unidentifiable causes.7

Frequency

United States

The actual incidence of mononeuritis multiplex in the United States is not known due to the widely varied underlying pathologies that may lead to the disorder. The primary disease process often is so dominant that the symptoms of mononeuritis multiplex simply are attributed to the initial disease and remain undiagnosed.

International

Same as frequency in the United States (see above).

Mortality/Morbidity

If the cause of mononeuritis multiplex is identified early and is successfully treated, full recovery is possible. The extent of disability varies, from no disability to partial or complete loss of function and movement.

Race

No race predilection is known for mononeuritis multiplex.

Sex

Mononeuritis multiplex exhibits equal incidence in men and women.

Age

Age of onset for mononeuritis multiplex depends on the patient's age at occurrence of the associated disease process; however, this condition does tend to occur in older patients with relatively mild or even unrecognized diabetes for unknown reasons.

Clinical

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 unilateral severe 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

Loss of sensation and movement may be associated with dysfunction of specific nerves. Examination reveals preservation of reflexes and good strength except in regions more profoundly affected. Some common findings of mononeuritis multiplex may include the following (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
  • Tardive ulnar palsy
  • Peroneal nerve palsy
  • Autonomic dysfunction - The part of the nervous system that controls involuntary bodily functions, such as the glands and the heart

Causes

Mononeuritis multiplex most commonly is associated with diabetes mellitus and multiple nerve compressions.

More on Mononeuritis Multiplex

Overview: Mononeuritis Multiplex
Differential Diagnoses & Workup: Mononeuritis Multiplex
Treatment & Medication: Mononeuritis Multiplex
Follow-up: Mononeuritis Multiplex
References
Further Reading
[ CLOSE WINDOW ]

References

  1. Vial C, Bouhour F. [Vasculitis multiple mononeuropathies]. Rev Prat. Nov 15 2008;58(17):1896-9. [Medline].

  2. Magy L. [What is a peripheral neuropathy?]. Rev Prat. Nov 15 2008;58(17):1873-7, 1880-1. [Medline].

  3. 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].

  4. 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].

  5. 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].

  6. 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].

  7. 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].

  8. 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].

  9. 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].

  10. Adams RD, Victor M, Ropper AH. Multiple mononeuropathy and radiculopathy. In: Principles of Neurology. 6th ed. New York, NY: McGraw-Hill; 1996:1326.

  11. Bajwa ZH. A rational polypharmacy for a complex phenomenon (neuropathic pain). 19th Annual Meeting of the American Pain Society. November 2-5, 2000.

  12. Braddom RL. Mononeuritis multiplex. In: Physical Medicine and Rehabilitation. Philadelphia, Pa: WB Saunders; 1996:986-7.

  13. Delisa JA. Mononeuropathy multiplex syndromes and plexopathies. In: Delisa JA, Gans BM, eds. Rehabilitation Medicine. Philadelphia, Pa: JB Lippincott; 1993:297-8.

  14. Dumitru D. Textbook of Electrodiagnostic Medicine. Philadelphia, Pa: Mosby; 1995.

  15. Farrar J, Hirsch J, Nicholson B. Novel approaches to the understanding and treatment of neuropathic pain. Program and Abstracts of the 19th Annual Scientific Meeting of the American Pain Society. Nov 2-5, 2000;Symposium Abstract 112.

  16. Galer B, Backonja M. Zonisamide for neuropathic pain: dose ranging pilot study. Program and Abstracts of the 19th Annual Scientific Meeting of the American Pain Society. November 2-5, 2000.

  17. Greenberg MS. Handbook of Neurosurgery. 4th ed. New York, NY: Thieme Medical Pub; 1990.

  18. Kimura J. Electrodiagnosis in Diseases of Nerve and Muscle: Principles and Practice. Philadelphia, Pa: FA Davis; 1989.

  19. Krendel DA, Costigan DA, Hopkins LC. Successful treatment of neuropathies in patients with diabetes mellitus. Arch Neurol. Nov 1995;52(11):1053-61. [Medline].

  20. Mahadevan A, Gayathri N, Taly AB, et al. Vasculitic neuropathy in HIV infection: a clinicopathological study. Neurol India. Sep 2001;49(3):277-83. [Medline].

  21. Olney RK. AAEM minimonograph #38: neuropathies in connective tissue disease. Muscle Nerve. May 1992;15(5):531-42. [Medline].

  22. Panicker JN, Nagaraja D, Ratnavalli E, et al. A rare cause for mononeuritis multiplex. Neurol India. Mar 2004;52(1):131-2. [Medline].

  23. Parry GJ. Mononeuropathy multiplex (AAEE case report #11). Muscle Nerve. Jul-Aug 1985;8(6):493-8.

  24. RxList. Zonegran. RxList. Available at http://www.rxlist.com/cgi/generic3/zonisamide_ad.htm. Accessed 3/13/09.

  25. Parker JN, Parker PM, eds. The Official Patient's Sourcebook on Peripheral Neuropathy: A Revised and Updated Directory for the Internet Age. San Diego, Calif: Icon Health Pub; 2002:156, 244.

  26. Wiederholt WC. Neurology for Non-neurologists. 4th ed. Philadelphia, Pa: WB Saunders; 2000:194.

[ CLOSE WINDOW ]

Keywords

mononeuritis multiplex, neuropathy, peripheral neuropathy, diabetic neuropathy, neuropathy treatment, neuropathy symptoms, neuropathy and peripheral, neuropathies, diabetic peripheral neuropathy, peripheral neuropathy symptoms, mononeuropathy multiplex, multifocal neuropathy, multiple mononeuropathy, peripheral polyneuritis, peripheral mononeuropathy

[ CLOSE WINDOW ]

Contributor Information and Disclosures

Author

Paul V Brooks, MD, Medical Director, Department of Physical Medicine and Rehabilitation, Lexington Clinic; Assistant Professor, Department of Physical Medicine and Rehabilitation, Departments of Ortho, Lexington Clinic
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.

Medical Editor

Daniel D Scott, MD, MA, BS, Associate Professor, Department of Physical Medicine and Rehabilitation, University of Colorado at Denver and Health Sciences Center
Daniel D Scott, MD, MA, BS is a member of the following medical societies: Alpha Omega Alpha, American Academy of Physical Medicine and Rehabilitation, American Association of Neuromuscular and Electrodiagnostic Medicine, American Paraplegia Society, Association of Academic Physiatrists, National Multiple Sclerosis Society, and Physiatric Association of Spine, Sports and Occupational Rehabilitation
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Michael T Andary, MD, MS, Residency Program Director, Professor, Department of Physical Medicine and Rehabilitation, Michigan State University College of Osteopathic Medicine
Michael T Andary, MD, MS is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation, American Association of Neuromuscular and Electrodiagnostic Medicine, American Medical Association, and Association of Academic Physiatrists
Disclosure: allergan Honoraria Speaking and teaching

CME Editor

Kelly L Allen, MD, Regional Medical Director, IMX-Medical Management Services
Disclosure: Nothing to disclose.

Chief Editor

Robert H Meier III, MD, Director, Amputee Services of America; Active Medical Staff, Presbyterian/St Luke's Hospital, Spalding Rehabilitation Hospital, Select Specialty Hospital; Consulting Staff, Kindred Hospital
Robert H Meier III, MD is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation and Association of Academic Physiatrists
Disclosure: Nothing to disclose.

 
 
HONcode

We subscribe to the
HONcode principles of the
Health On the Net Foundation

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

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.