QuestionSBA
QuestionChoice
Motor neurone disease presents with gradual progression of upper and lower motor neurone signs. It would not present with the sensory deficit and would not present as rapidly as this
33096
d
Motor neurone disease
QuestionChoice
Multiple sclerosis typically presents with temporary visual or sensory loss with gradual progression. It can cause spastic weakness, ataxia, and tremor, but wouldn't present with sudden neurological deficit
33094
b
Multiple sclerosis
QuestionChoice
Syringomyelia presents with a bilateral loss of sensation to pain and temperature, but with sparing of light touch, vibration, and proprioception. It typically affects the neck, shoulders, and arms when a syrinx is present in the cervical spine. While it can present suddenly with sensory loss, it would not provide the pattern of distribution found in this patients examination findings
33097
e
Syringomyelia
QuestionChoice
This patient is experiencing symptoms of mononeuritis multiplex, sporadically developing peripheral neuropathies most commonly from nerve ischaemia secondary to primary or secondary vasculitis. There are multiple causes for this, broadly classifying them into ischaemic (e.g. diabetes mellitus & peripheral nerve vasculitis), inflammatory (e.g. sarcoidosis, rheumatoid arthritis, and Guillain-Barré Syndrome), infectious (e.g. Lyme disease and cytomegalovirus), drug-induced (sulfonamides and hydralazine), genetic, malignant, or primary vasculitides (e.g. giant cell arteritis, granulomatosis with polyangiitis, or polyarteritis nodosa)
33093
a
Rheumatoid arthritis
QuestionChoice
B12 deficiency presents with gradually progressive peripheral paraesthesia. It would not present with such sudden onset with a seemingly random distribution of the peripheral nerves
33095
c
B12 deficiency
QuestionComment
FML
8139
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I both second and third this
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Jaundice Dermis
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4th, 5th and 6th 
18773
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Gallbladder Tachycardia
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Samoan Joe 
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lmao what

8810
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Yellow Zebras
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NicheMed
22140
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Camiodarone
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just say mononeuritis multiplex :(
22688
QuestionComment
In finals, most exams will have 2 step qs such as this. Step 1 is identifying this is mononeuritis multiplex, step 2 is knowing what conditions cause that.
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Ale
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Acute Sclerosis
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ooof

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Axillary Stasis
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If i speak I am in big trouble, in big trouble
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Gabriel Magalhaes
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Any one else know it was mononeuritis multiplex but BLANK on the causes FML 

62178
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j.g.73
Concept
Chapter
# Summary

Mononeuritis multiplex is a form of peripheral neuropathy that affects multiple individual nerves in different parts of the body. It typically begins asymmetrically, but as more nerves become involved, the condition can mimic polyneuropathy. It commonly presents with both motor and sensory deficits and can cause significant pain. Early recognition is crucial for distinguishing it from other neuropathies and for targeting appropriate management.

# Definition

Mononeuritis multiplex refers to the involvement of two or more non-contiguous peripheral nerves. Initially, the pattern is asymmetrical, with different nerves affected either sequentially or simultaneously. As the disease progresses, the deficits can become more confluent and symmetrical, making it harder to differentiate from polyneuropathy. The condition typically presents with a sudden or subacute loss of sensory and motor function in the affected nerves.


# Aetiology 

Mononeuritis multiplex can be caused or associated with various systemic conditions, including:

- **Diabetes mellitus** – one of the most common causes, often presenting as painful neuropathy in lower limbs.
- **Vasculitis** – including polyarteritis nodosa, granulomatosis with polyangiitis (Wegener's), and eosinophilic granulomatosis with polyangiitis (Churg-Strauss). It can also occur secondary to **Rheumatoid Arthritis**
- **Autoimmune disorders** – such as rheumatoid arthritis and systemic lupus erythematosus.
- **Infectious causes** – including leprosy, Lyme disease, HIV, and Parvovirus B19.
- **Sarcoidosis** – a granulomatous disease affecting multiple systems.
- **Cryoglobulinaemia** – immune-complex-related vasculitis.
- **Exposure to toxins** – such as trichloroethylene or drugs like dapsone.
- **Rare causes** – such as reactions following stings from jellyfish like the sea nettle.

# Clinical Features

The hallmark feature of mononeuritis multiplex is **asymmetry** in sensory and motor disturbances:

- **Pattern of involvement**: Patients often experience asymmetric weakness or sensory deficits, particularly affecting the distribution of specific nerves.
- **Nerve involvement**: 
  - **Peroneal nerve involvement** is common in up to 75% of cases, leading to foot drop.
  - Other frequently affected nerves include the **tibial**, **ulnar**, **radial**, and **median** nerves.
- **Pain**: Often deep and aching, worse at night, and typically in the lower back, hips, or legs.
- **Diabetic mononeuritis multiplex**: Commonly presents with acute, severe, unilateral thigh pain followed by weakness in the quadriceps and loss of the knee reflex.

As the disease advances, the sensory and motor deficits may become more symmetrical, which can obscure the diagnosis.

# Management 

The treatment of mononeuritis multiplex involves both addressing the underlying condition and managing the neuropathic symptoms:

1. **Conservative management**:
   - **Physical therapy (PT)** to maintain function in affected limbs.
   - **Orthotics** (such as foot braces) to support foot drop and other motor impairments.
   
2. **Medical management**:
   - **Optimising underlying conditions** such as controlling blood sugar levels in diabetes, or using immunosuppressive therapy in autoimmune or vasculitic cases.
   - **Pain management**: Neuropathic pain can be managed using medications such as:
     - **Anticonvulsants** (e.g., gabapentin or pregabalin).
     - **Antidepressants** (e.g., amitriptyline or duloxetine).
     - **Analgesics** or **opioids** in severe cases.
   - **IVIG** (Intravenous Immunoglobulin): In some cases, especially those related to immune-mediated causes, IVIG may be used as part of the treatment plan to modulate the immune response.



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Quesmed Tutorial: Advanced Neurology
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Mononeuritis multiplex can occur in rheumatoid arthritis, presenting as multiple isolated peripheral neuropathies due to nerve ischaemia or inflammation.
A 52-year-old woman presents to the GP with acute right foot drop and loss of sensation on the dorsum of the foot. One month ago, she developed ulnar nerve palsy in her left hand, and six months ago, she had developed isolated 4th nerve palsy.

Which of the following conditions is associated with this disorder?
a