00:01
Here, we’ll take a look at
mononeuritis multiplex.
00:05
Mono neuritis.
00:06
Multiplex is a painful, asymmetrical,
peripheral neuropathy,
affecting
at least two areas on the same nerve.
00:13
It is important to be aware that nerves
throughout the body can be affected.
00:19
Possible etiologies:
diabetes,
or vasculitides with or without connective
tissue disease or infection related.
00:30
Maybe it’s hepatitis B virus,
HIV, hepatitis C virus.
00:34
And one that you should know quite
well is that polyarteritis nodosa
may also present with
mononeuritis multiplex.
00:45
Other causes including leprosy,
Lyme disease, sarcoidosis,
or hereditary neuropathy with
liability to pressure palsies,
all possible causes of one nerve being
affected in multiple locations.
01:01
Let’s have a view on the clinical presentation
of mononeuritis multiplex.
01:05
This is a patterned involvement of a single
nerve at multiple sites.
01:09
This could be sequential or simultaneous.
This is in contrast to polyneuropathy.
01:15
Its clinical presentation shows involvement
of multiple nerves at the site.
01:20
For a diagnostic workup you use EMG nerve
conduction velocity tests to confirm neuropathy.
01:25
Besides this you should use an etiology-specific
diagnostic workup based on other associated symptoms
to identify the cause.The treatment depends
on the identification of the etiology.
01:38
For instance, immunomodulation therapy for necrotizing
vasculitides as a cause of mononeuritis multiplex
is associated with significant motor and sensory improvement.
Anti-convulsants can be used to
help with neuropathic pain.
Corticosteroids are helpful in some cases.
01:56
In summary:
Risk factors: Diabetes,
family history.
02:02
Preventative medicine: Well,
good control of blood sugar
if you’re suspecting diabetes
because there’s every possibility
that you have many nerves
that might be affected.
02:10
Signs and symptoms: Well, it depends
on which nerve has been affected.
02:15
For example, if it’s a nerve down in
the leg, then it’s common peroneal.
02:18
You might have –
A patient experiences foot drop or maybe
it’s radial nerve also being affected.
02:27
So therefore, there’s wrist drop,
same patient, multiple nerves --
– or excuse me,
multiple locations.
02:34
One nerve in each
location being affected.
02:37
Diagnostic workup:
EMG, electromyogram,
appropriate labs.
02:42
And treatment here would be,
well, etiology-specific.