Abstract Lyme neuroborreliosis (LNB) typically presents as a painful radiculitis or a cranial mononeuropathy with lymphocytic meningitis (Bannwarth's syndrome). [pubmed.ncbi.nlm.nih.gov]

Reports of initial presentation with MM are rare [3],[8],[9]. [bmcneurol.biomedcentral.com]

Mononeuritis multiplex can sometimes be the initial presentation of SLE[ 1 ]. Confirmation of diagnosis is by nerve biopsy and nerve conduction studies. [escholarship.org]

Although other organ systems are often involved, the initial clinical presentation of systemic vasculitis may involve only the peripheral nervous system. [casemed.case.edu]

Cardiovascular autonomic neuropathy was present in two of the patients and there was improvement after treatment in the Ewing's tests – Valsalva manoeuvre, deep‐breathing test and lying‐to‐standing test. [onlinelibrary.wiley.com]

• Amyloidosis

  Cutaneous nerve biopsy may help establish a precise diagnosis (eg, polyarteritis, amyloidosis). In about half of cases, no specific cause can be established; of these, slightly less than half are subsequently found to be familial. [accessmedicine.mhmedical.com]

  Common conditions include: Blood vessel diseases such as polyarteritis nodosa Connective tissue diseases such as rheumatoid arthritis or systemic lupus erythematosus (the most common cause in children) Diabetes Less common causes include: Amyloidosis, [medlineplus.gov]

  […] disorders Clinical Information A painful asymmetric asynchronous sensory and motor peripheral neuropathy involving isolated damage to at least 2 separate nerve areas; associated with (but not limited to) systemic disorders such as diabetes, vasculitis, amyloidosis [icd10data.com]

  Primary amyloidosis presenting as upper limb multiple mononeuropathies. Muscle Nerve. 2010 May. 41(5):710-5. [QxMD MEDLINE Link]. [Full Text]. Le Clech L, Rizcallah MJ, Alavi Z, Hutin P. [emedicine.medscape.com]

• Fatigue

  Approximately 8 years later, the patient started to develop numbness also in the right forefoot, along with symptoms of evening fatigue and occasional orthostatic hypotension. [pubmed.ncbi.nlm.nih.gov]

  Clinically she was almost pain free, but suffered severe fatigue. Within three months, she stopped medication against medical recommendation and worsened in the following eight weeks, with severe neuropathic pain and inability to walk autonomously. [bmcneurol.biomedcentral.com]

  Unspecific symptoms, such as weight loss, fever or fatigue, have been reported in 80% of neuropathy with systemic vasculitis and in about 50% of patients with nonsystemic vasculitic neuropathy (NSVN). [ncbi.nlm.nih.gov]

• Candidiasis

  The patient also reported recurrent candidiasis in glans and intergluteal areas since adolescence. Electromyoneurography of lower and upper limbs revealed the presence of multiple mononeuropathies. [pubmed.ncbi.nlm.nih.gov]

• Hypotension

  Approximately 8 years later, the patient started to develop numbness also in the right forefoot, along with symptoms of evening fatigue and occasional orthostatic hypotension. [pubmed.ncbi.nlm.nih.gov]

• Orthostatic Hypotension

  Approximately 8 years later, the patient started to develop numbness also in the right forefoot, along with symptoms of evening fatigue and occasional orthostatic hypotension. [pubmed.ncbi.nlm.nih.gov]

• Vascular Disease

  Abstract Mononeuropathy multiplex is a syndrome of diverse causes, the most common of which is nerve ischemia due to microangiopathy associated with diabetes or the collagen-vascular diseases. [pubmed.ncbi.nlm.nih.gov]

• Numbness of the Feet

  Description of case 1 A 47 year old man with a four year history of type 2 diabetes, treated with an oral hypoglycaemic agent, had had mild symmetrical numbness in the feet for four years. [jnnp.bmj.com]

• Mononeuropathy

  Concepts Disease or Syndrome (T047) MSH D020422 ICD10 G58.9 SnomedCT 304595001, 128189008 English Mononeuropathy, unspecified, Mononeuropathy NOS, Mononeuropathies, Mononeuropathies [Disease/Finding], mononeuropathy, mononeuropathies, Mononeuropathy, [fpnotebook.com]

  Mononeuropathy multiplex affect nerve trunks that cause dysesthesias and paresthesias and are usually caused by ischemia to the vasa nervorum. Keywords Mononeuropathy Mononeuropathy multiplex Vasculitic neuropathy References 1. [link.springer.com]

  A case of mononeuropathy multiplex associated with polyarteritis nodosa is described. Similar articles Electrodiagnostic approach to the patient with suspected mononeuropathy of the upper extremity. Herrmann DN, Logigian EL. Herrmann DN, et al. [pubmed.ncbi.nlm.nih.gov]

  […] specified mononeuropathies of left lower limb G57.83 Other specified mononeuropathies of bilateral lower limbs G57.9 Unspecified mononeuropathy of lower limb G57.90 Unspecified mononeuropathy of unspecified lower limb G57.91 Unspecified mononeuropathy [icd10data.com]

  People with certain medical conditions such as diabetes may be at higher risk of developing mononeuropathy. Symptoms and Causes What causes mononeuropathy? The causes of mononeuropathy vary depending on the affected nerves. [my.clevelandclinic.org]

• Peripheral Neuropathy

  Nerve biopsy showed features of vasculitic neuropathy and nerve conduction velocity studies were consistent with sensory and mild motor and axonal demyelinating peripheral neuropathy. [escholarship.org]

  PMID: 17290934 [An autopsy case of systemic vasculitis associated with hepatitis C virus-related mixed cryoglobulinemia presenting severe peripheral neuropathy]. [pubmed.ncbi.nlm.nih.gov]

  More information on Mononeuritis Multiplex Foundation for Peripheral Neuropathy American Chronic Pain Association [aanem.org]

  Peripheral neuropathy Peroneal neuropathy Polyneuropathy Polyradiculopathy Sciatic neuropathy Sensory neuropathy Small fiber neuropathy Tingling and numbness Research advances that improve clinical care Doctors in the Peripheral Nerve Division actively [mayoclinic.org]

  This is in contradistinction to the typical pattern of most peripheral neuropathies that are symmetric and length dependent ("stocking-glove pattern"). [casemed.case.edu]

• Numbness of the Hand

  Case report: A 49-year-old man developed numbness in right hand and forearm. After 6 months, the patient developed left forefoot numbness. [pubmed.ncbi.nlm.nih.gov]

  CASE REPORT: A 49-year-old man developed numbness in right hand and forearm. After 6 months, the patient developed left forefoot numbness. [europeanreview.org]

• Foot Drop

  For example, sudden loss of the ability to lift the foot normally while walking (foot drop) can be caused by mononeuritis multiplex, when it is accompanied by loss of nerve function elsewhere in the body. [medicinenet.com]

  Examination showed severe weakness and atrophy in the right interossei with normal strength in the abductor digiti minimi, and left foot drop. [jnnp.bmj.com]

• Excitement

  PMID: 22614870 Nerve excitability testing and its clinical application to neuromuscular diseases. Nodera H, Kaji R. Nodera H, et al. Clin Neurophysiol. 2006 Sep;117(9):1902-16. doi: 10.1016/j.clinph.2006.01.018. Epub 2006 Apr 24. [pubmed.ncbi.nlm.nih.gov]

Laboratory workup includes a complete blood count, serum protein electrophoresis with reflex to immunofixation or immunotyping, determination of plasma urea and electrolytes, liver biochemical tests, thyroid function tests, vitamin B12 level, tests for [accessmedicine.mhmedical.com]

Typically, the condition is associated with (but not limited to) systemic disorders such as the following (see Causes, Presentation, Workup, and Treatment): Vasculitis [4, 5, 6, 7] Amyloidosis [8] Direct tumor involvement - Lymphoma, leukemia [9, 10] [emedicine.medscape.com]

Investigations Blood workup revealed normocytic anemia, thrombocytosis and increased erythrocyte sedimentation rate (ESR) (110 mm/h), C-reactive protein (CRP) (33 mg/L) and angiotensin converting enzyme (ACE) (74 units/L). [bmcneurol.biomedcentral.com]

Management and Treatment How is mononeuropathy treated? Treatment for mononeuropathy depends on the type of nerves that are affected. Treatments include: Removal of pressure. Corticosteroid injections. Splints to immobilize the area. [my.clevelandclinic.org]

Severe exacerbation of hepatitis C-associated vasculitic neuropathy following treatment with interferon alpha: a case report and literature review. Boonyapisit K, Katirji B. Boonyapisit K, et al. [pubmed.ncbi.nlm.nih.gov]

On the 10th day, we established a decrease in total symptom score by an average of 2.7 ± 1.4 points and by the end of the treatment period it was improved by 5.9 ± 1.9 points (p = 0.04). [onlinelibrary.wiley.com]

We also noted marked improvement in pain in these patients with treatment. One patient failed to respond to treatment initially, but had eventual improvement over a two year period. [jnnp.bmj.com]

If no improvement can be seen, combination of antiviral and immunosuppressive treatment is necessary (see treatment). [ncbi.nlm.nih.gov]

Outlook / Prognosis What is the prognosis for mononeuropathy? It is important that mononeuropathy be treated when recognized. If caught early, long-term disability may be able to be avoided. [my.clevelandclinic.org]

When they are not, electrodiagnostic testing is done to establish the diagnosis, localize the lesion, assess severity, and estimate prognosis. Underlying disorders are treated. Click here for Patient Education NOTE: This is the Professional Version. [msdmanuals.com]

Medicines that may help include: Over-the-counter or prescription pain drugs Antiseizure or antidepressant drugs to reduce stabbing pains Outlook (Prognosis) A full recovery is possible if the cause is found and treated, and if the nerve damage is limited [ufhealth.org]

A population-based and cross-sectional study of the long-term prognosis in multifocal motor neuropathy. J Peripher Nerv Syst. 2019 Feb 12. [QxMD MEDLINE Link]. Said G, Lacroix-Ciaudo C, Fujimura H, et al. [emedicine.medscape.com]

PAN is mostly a monophasic disease and the prognosis depends on the involved organ systems. If the heart or the central nervous system is involved, prognosis is poor. [ncbi.nlm.nih.gov]

When the etiology involves inflammation, the term mononeuritis multiplex is used. In most cases, the individual neuropathies are of named nerves (i.e., median, ulnar, peroneal, etc.) as opposed to small nerve twigs. [casemed.case.edu]

Pathophysiology and Etiology 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) and therefore interferes with nerve conduction. [emedicine.medscape.com]

The etiology has remained elusive although an association of IIH with numerous conditions has been reported: Endocrine abnormalities that have been reported include menstrual irregularities [1], adrenal insufficiency [2], hypoparathyroidism [3], and hypothyroidism [kundoc.com]

Case report Open Access Published: 11 December 2014 BMC Neurology volume 14, Article number: 237 (2014) Cite this article 4247 Accesses 9 Citations Metrics details Abstract Background Several disorders may present with mononeuritis multiplex and the etiological [bmcneurol.biomedcentral.com]

Epidemiological, clinical and laboratory profiles of cutaneous polyarteritis nodosa patients: Report of 22 cases and literature review. Autoimmun Rev. 2016 Jun. 15 (6):558-63. [QxMD MEDLINE Link]. Lee P, Bruni J, Sukenik S. [emedicine.medscape.com]

Clinical and epidemiologic aspects. [ncbi.nlm.nih.gov]

Pathogenesis Inflammation of the walls of nutrient and epineural arteries is the main pathophysiological feature in vasculitic neuropathy. [ncbi.nlm.nih.gov]

A larger study is required to explore the pathophysiology, natural history, and possible treatment options for patients with mononeuritis multiplex in diabetes. [jnnp.bmj.com]

Pathophysiology and Etiology 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) and therefore interferes with nerve conduction. [emedicine.medscape.com]

Prevention Preventive measures depend on the specific disorder. For example, with diabetes, eating healthy foods and keeping a tight control of blood sugar may help prevent multiple mononeuropathy from developing. Images References Katirji B. [ufhealth.org]

Shoes should be examined frequently during the day for grit or foreign objects in order to prevent pressure lesions. [accessmedicine.mhmedical.com]

Preventive measures depend on the specific disorder. For example, with diabetes, eating healthy foods and keeping a tight control of blood sugar may help prevent multiple mononeuropathy from developing. [medlineplus.gov]

Accurate diagnosis is important, as interferon-alpha may prevent transition to chronic hepatitis/cirrhosis. Similar articles Hepatitis C infection, cryoglobulinemia, and vasculitic neuropathy. [pubmed.ncbi.nlm.nih.gov]

Mononeuritis multiplex from vasculitis requires urgent treatment to prevent further progression and disability. [casemed.case.edu]