Health Encyclopedia

Mononeuritis multiplex

Definition

Mononeuritis multiplex is a brain/nervous system (neurological) disorder that involves damage to at least two separate nerve areas.

Alternative Names

Mononeuropathy multiplex; Multifocal neuropathy

Causes, incidence, and risk factors

Mononeuritis multiplex is a form of damage to nerves outside the brain and spinal cord (peripheral neuropathy). It is a group of symptoms, not a disease. A part of the nerve cell called the axon is destroyed, which interferes with nerve signaling.

The cause of mononeuritis multiplex affects nerves in many areas. As the disorder gets worse, the damage may become more widespread and affect more nerves. Common causes include:

A lack of oxygen from decreased blood flow
Swelling and irritation (inflammation) of blood vessels

No cause is found in about a third of cases.

Common causes of mononeuritis multiplex include:

Blood vessel diseases such as polyarteritis nodosa
Connective tissue diseases such as rheumatoid arthritis or systemic lupus erythematosus
Diabetes mellitus

Connective tissue disease is the most common cause of mononeuritis multiplex in children.

Less common causes include:

Amyloidosis
Disorders of the blood (such as hypereosinophilia and cryoglobulinemia)
Infections such as Lyme disease
Leprosy
Sarcoidosis
Sjogren syndrome
Wegener's granulomatosis

Symptoms

Abnormal sensation
Burning pain
Difficulty moving a part of the body (paralysis)
Inability to move a part of the body
Lack of control over movement in a part of the body
Lack of or decreased sensation in any part of the body
Numbness and tingling

Specific symptoms depend on the nerve involved.

Signs and tests

A detailed history is needed to determine the possible cause of the disorder. Examination and neuromuscular testing may show a loss of feeling and movement due to problems with specific nerves. Reflexes may be abnormal.

To diagnose mononeuritis multiplex usually requires problems with two or more unrelated nerve areas. Common findings may include the following:

Tests that may be done include:

Other possible tests include:

Treatment

The goals of treatment are to:

Treat the cause, if possible
Provide supportive care to maximize independence
Control symptoms (this may include controlling blood sugar levels for diabetics, nutritional supplementation, or medical treatment of conditions)

To improve independence, treatments may include:

Occupational therapy
Orthopedic help (for example, appliances such as wheelchairs, braces, and splints)
Physical therapy (for example, exercises and retraining to increase muscle strength)
Vocational therapy

Safety is an important consideration for people with sensation or movement difficulties. Lack of muscle control and decreased sensation may increase the risk of falls or injuries. Safety measures for people with movement difficulty may include:

Adequate lighting (including leaving lights on at night)
Railings
Removing obstacles (such as loose rugs that may slip on the floor)
Testing water temperature before bathing
Wearing protective shoes (no open toes or high heels)

Check shoes often for grit or rough spots that may injure the feet.

People with decreased sensation should check their feet (or other affected area) often for bruises, open skin areas, or other injuries that may go unnoticed. These injuries may become severely infected because the pain nerves of the area are not signalling the injury.

People with mononeuropathy multiplex are prone to new nerve injuries at pressure points such as knees and elbows. They should avoid putting pressure on these areas, for example by not leaning on the elbows, crossing the knees, or holding similar positions.

Over-the-counter analgesics or prescription pain medications may be needed to control pain (neuralgia). Other medications, including anticonvulsants (gabapentin, phenytoin, carbamazepine) or tricyclic antidepressants, may be used to reduce the stabbing pains that some people experience. Whenever possible, avoid or minimize the use of medications to reduce the risk of side effects.

Positioning (the use of frames to keep bedclothes off of a tender body part) and other measures may help control pain. Autonomic symptoms can be difficult to treat or respond poorly to treatment.

Expectations (prognosis)

If the cause can be found and successfully treated, and if damage is limited, a full recovery is possible. The amount of disability can range from no disability, to partial or complete loss of movement, function, or sensation.

Nerve pain may be quite uncomfortable and can last for a long time. If this occurs, see a pain specialist to ensure that all pain treatment options are available to you.

Complications

Decreased self-esteem
Deformity, loss of tissue mass
Disturbances of organ functions
Recurrent or unnoticed injury to any part of the body
Relationship problems due to impotence

Calling your health care provider

Call your health care provider if you notice signs of mononeuritis multiplex.

Prevention

Prevention techniques vary depending on the specific disorder. Proper diet and use of medication for diabetes may help prevent neuropathy from developing.

Review Date:9/25/2008
Reviewed By:Daniel B. Hoch, PhD, MD, Assistant Professor of Neurology, Harvard Medical School, Department of Neurology, Massachusetts General Hospital. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.

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