Mononeuritis multiplex is a nervous system disorder that involves damage to at least two separate nerve areas.
Mononeuropathy multiplex; Multifocal neuropathy; Peripheral neuropathy – mononeuritis multiplex
Causes, incidence, and risk factors
Mononeuritis multiplex is a form of damage to one or more peripheral nerves — the nerves outside the brain and spinal cord. It is a group of symptoms (syndrome), not a disease.
However, certain diseases can cause the injury or nerve damage that leads to the symptoms of mononeuritis multiplex. Common conditions include:
Blood vessel diseases such as
Connective tissue diseases such as
rheumatoid arthritisor systemic lupus erythematosus(the most common cause in children)
Less common causes include:
Blood disorders (such as hypereosinophilia and cryoglobulinemia)
Infections such as
Sarcoidosis Sjogren syndrome Wegener’s granulomatosis
Symptoms will depend on the specific nerves involved, and may include:
Loss of bladder or bowel control
Loss of sensation in one or more areas of the body
Paralysisin one or more areas of the body
Tingling, burning, pain, or other abnormal sensations in one or more areas of the body
Weakness in one or more areas of the body
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, there usually needs to be problems with two or more unrelated nerve areas. Common nerves affected are the:
Axillary nervein either arm and shoulder Common peroneal nervein the lower leg Distal median nerveto the hand Femoral nervein the thigh Radial nervein the arm Sciatic nervein the back of the leg Ulnar nervein the arm
Tests may include:
Electromyogram(EMG, a recording of electrical activity in the muscles)
Nerve biopsyto examine the nerve under a microscope
Nerve conduction teststo measure how fast nerve impulses move along the nerve
Other tests may include:
Antinuclear antibody panel(ANA)
- Blood chemistry tests
- Imaging scans
- Pregnancy test
Rheumatoid factor Sedimentation rate
- Thyroid tests
The goals of treatment are to:
Treat the illness that is causing the problem, if possible
Provide supportive care to maximize independence
Control symptoms (this may include controlling
blood sugar levelsfor diabetics, nutritional supplementation, or medically treating conditions)
To improve independence, treatments may include:
Orthopedic help (for example, appliances such as wheelchairs, braces, and splints)
Physical therapy (for example, exercises and retraining to increase muscle strength)
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 include:
Adequate lighting (including leaving lights on at night)
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 signaling 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.
Medications that may help include:
Over-the-counter pain medicines (ibuprofen or acetaminophen) or prescription pain medications may be needed to control pain (
Anticonvulsants (gabapentin, phenytoin, carbamazepine, or pregabalin) or antidepressants (amitriptyline, nortriptyline, or duloxetine), may be used to reduce stabbing pains.
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.
A full recovery is possible if the cause is found and treated, especially if the nerve damage is limited. Some people have no type of disability. Others have a partial or complete loss of movement, function, or sensation.
e pain may be quite uncomfortable and can last for a long time. If this occurs, see a pain specialist to discuss all pain treatment options available to you.
- Deformity, loss of tissue or muscle mass
- Disturbances of organ functions
- Medication side effects
- Repeated or unnoticed injury to the affected area due to lack of sensation
- Relationship problems due to
Calling your health care provider
Call your health care provider if you notice signs of mononeuritis multiplex.
Preventive measures vary depending on the specific disorder. Eating a proper diet and taking medication for diabetes may help prevent mononeuritis multiplex from developing.