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Vasculitic Mononeuritis Multiplex — RACP Adult Medicine MCQ

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ModerateNeurologyVasculitic Mononeuritis MultiplexRACP Adult Medicine

A 60-year-old man with ANCA-positive vasculitis presents with asymmetric weakness: right foot drop (peroneal nerve), left wrist drop (radial nerve), and left ulnar neuropathy. These developed sequentially over 2 weeks. NCS shows multifocal axonal neuropathy affecting individual nerves. What is the most likely type of neuropathy?

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Correct answer: D — Mononeuritis multiplex (vasculitic)

Sequential asymmetric involvement of individual named peripheral nerves (mononeuritis multiplex pattern) with axonal changes on NCS in the context of ANCA vasculitis is vasculitic mononeuritis multiplex. It results from vasculitis of the vasa nervorum causing ischaemic nerve injury. Common in PAN, EGPA, GPA, and cryoglobulinaemia. Treatment addresses the underlying vasculitis (immunosuppression). Nerve biopsy may confirm necrotising vasculitis.

Reference: eTG Neurology – 2024 – Mononeuritis Multiplex; ACR 2024