a.k.a. Multi-focal Mononeuropathy

Presentation

• Individual main nerve being knocked out in a random but sequential order

  • e.g. Median Nerve Injury → Ulnar Nerve Injury → next main nerve

• Red flag

  • NOT DISTAL
    • Hand onset
    • proximal or cranial nerve involvement
    • motor-predominant symptom
  • NOT SYMMETRICAL
    • Asymmetric onset
    • Patchy exam findings
    • Disproportionate reflex loss

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Late stage: become confluent, may mimic DSP → Distal Symmetric Polyneuropathy

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Etiology

• Autoimmune:

  • Vasculitis (Medium Vessel Vasculitis, MPA - Microscopic Polyangiitis)
  • !GBS - Guillain-Barré syndrome (less likely presentation)

• Metabolic: Diabetes Mellitus

• Infection: Lyme Disease, Leprosy (uncommon)

• Malignancy: Neurofibromatosis

  

Investigation

CXR: for TB, Sarcoid