Early detection of mononeuritis multiplex & diagnosis of systemic diseases thru electrophysiological work out with polyneuropathy as preceeding symptom

Abstract

Background: Mononeuritis multiplex (MNM) is a nervous system disorder that involves damage to at least two separate peripheral nerves. It is a syndrome not a disease, caused by certain systemic diseases like diabetes, vasculitis, rheumatic, infectious or paraneoplastic diseases. Objective: To evaluate the role of electrophysiological work out on patients presenting with polyneuropathy as preceding symptom that leads to early diagnosis of MNM and an underlying systemic disease. Patients: We retrospectively analyzed 12 MNM patients (4 females and 8 males from 19 to 62 years of age) presenting with patchily distributed weakness in all and pain at onset in nine, at our neuromuscular diseases clinic between 1993-2013. We have obtained Institutional Review Board (IRB) approval, as necessary. Methods: Neurophysiological evaluation, routine blood chemistry, vasculitis markers, serum and protein electrophoresis, HIV, Hepatitis markers were examined in all patients. Nerve and muscle biopsies were performed in 5 patients. Results: Neurophysiological evaluation revealed an asymmetrically distributed motor and sensory nerve involvement accompanied by neurogenic findings in all. Nerve and muscle biopsies were performed in five. The differential diagnostic work up of this patient group resulted in diagnosis of 2 Churg- Strauss syndrome, 2 rheumatoid arthritis, 2 non-necrotizing vasculitis, 2 PAN and 1 multiple myeloma, 1 CNS vasculitis related to p-ANCA, 1 Hepatitis C and 1 HIV. Conclusion: Detailed investigation of patients with polyneuropathy as preceding symptom thru electrophysiological work out can be a valuable tool that leads to early detection and treatment of MNM and the underlying systemic disease.