Mononeuropathy

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.