How are HIV-associated multiple mononeuropathies diagnosed?

Updated: Oct 23, 2019
  • Author: Emad R Noor, MBChB; Chief Editor: Niranjan N Singh, MBBS, MD, DM, FAHS, FAANEM  more...
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Answer

Answer

The multiple mononeuropathies are typically inflammatory in nature and may involve single or multiple cranial or peripheral nerves. They vary with the stage of HIV infection. [16]

The patient describes multifocal asymmetric sensory or motor complaints in the distribution of cranial nerves, [3] peripheral nerves, or nerve roots. Cranial neuropathies most commonly involve the facial nerve (also known as Bell's palsy) and can be unilateral or bilateral. Facial paralysis in HIV patients does not differ clinically from typical Bell's palsy. 

Physical findings include asymmetric weakness and reflex and sensory loss. More severe involvement suggests cytomegalovirus (CMV) infection. Progression may change presentation from multifocal mononeuropathies to a more generalized polyneuropathy. 

Blood for CMV polymerase chain reaction (PCR) analysis should be sent if HIV-associated multiple mononeuropathy is suspected. [19]

Electromyographic (EMG) and nerve conduction studies show asymmetric multifocal involvement with axonal degeneration, and the CSF will show an elevated protein level and pleocytosis.

Magnetic resonance imaging with contrast can be useful if suspecting CNS lymphoma.


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