What is Mononeuritis Multiplex?
Mononeuritis multiplex is a type of painful peripheral neuropathy, which is caused by damage to two or more different areas of the nerve. Mononeuritis multiplex is actually a syndrome, which consists of a group of symptoms, such as numbness, tingling, decreased or absence of sensation, abnormal sensation, not being able to move a part of the body or difficulty in controlling movement.
In mononeuritis multiplex, there can be involvement of multiple nerves in random regions of the patient’s body. As there is worsening of mononeuritis multiplex, this condition becomes more localized and symmetrical. Mononeuropathy multiplex can be distributed bilaterally, proximally and distally all over the body.
What are the Causes & Risk Factors for Mononeuritis Multiplex?
The cause of mononeuritis multiplex is damage to the nerve. Nerve damage can occur in the following conditions in which mononeuritis multiplex is often associated with:
Mononeuritis multiplex is often associated with systemic diseases, such as diabetes mellitus, amyloidosis, vasculitis, direct involvement of tumor, rheumatoid arthritis, polyarteritis nodosa, Celiac disease, neurosarcoidosis, paraneoplastic syndromes and systemic lupus erythematosus.
Mononeuritis multiplex can also be associated with the following infections, such as leprosy, Lyme disease, acute viral hepatitis A, B & C, herpes simplex virus infection, acute parvovirus B-19 infection and AIDS and HIV infection.
The following hematologic conditions can also display mononeuritis multiplex: Hypereosinophilia, Churg-Strauss syndrome, Atopy-related peripheral neuritis, cryoglobulinemia and idiopathic thrombocytopenic purpura.
Other miscellaneous conditions can also be related with mononeuritis multiplex: Amphetamine angiitis and gasoline sniffing.
Who is at Risk for Developing Mononeuritis Multiplex?
Mononeuritis Multiplex can affect anybody; however, individuals suffering from connective tissue diseases or diabetes mellitus are at an increased risk to develop Mononeuritis Multiplex. Another common cause of Mononeuritis Multiplex is decreased oxygen supply caused by diminished blood flow, which is commonly caused by vasculitis. Vasculitis can be seen in many conditions, such as polyarteritis nodosa, systemic lupus erythematosus, rheumatoid arthritis, scleroderma and Wegener’s granulomatosis and this is why Mononeuritis Multiplex is commonly associated with these conditions.
What are the Symptoms of Mononeuritis Multiplex?
Symptoms of Mononeuritis Multiplex depend on the nerves, which are affected. Some of the symptoms of Mononeuritis Multiplex are:
- Loss of sensation in one or more parts of the body.
- Paralysis in one or more areas of the body.
- Loss of bowel or bladder control.
- Weakness in one or more areas of the body.
Pain, burning, tingling, or other such type of abnormal sensations in one or more parts of the body.
How is the Diagnosis of Mononeuritis Multiplex Made?
The following tests are done for diagnosis of Mononeuritis Multiplex:
- Electromyogram (EMG) to record the electrical activity in the muscles.
- Nerve biopsy to microscopically examine the nerve.
- Nerve conduction tests to assess the speed of the nerve impulses along the nerves.
Additional tests include: Blood chemistry tests, antinuclear antibody panel (ANA), C-reactive protein, x-rays, imaging scans, sedimentation rate, rheumatoid factor and thyroid tests.
How is Mononeuritis Multiplex Treated?
Mononeuritis Multiplex is treated by identifying and treating its underlying cause. Full recovery of the patient can be expected if the cause if identified and treated on time.
The aim of treatment for Mononeuritis Multiplex is:
- Treating the underlying illness, which are causing Mononeuritis Multiplex.
- Controlling and managing the symptoms of Mononeuritis Multiplex.
- Providing supportive care to the patient to improve patient’s independence.
Treatment for Mononeuritis Multiplex Consists of:
Therapy in Mononeuritis Multiplex
Medications in Mononeuritis Multiplex
The following medications are helpful in treating Mononeuritis Multiplex:
Over-the-counter pain medicines, such as acetaminophen or ibuprofen, to help relieve the pain in Mononeuritis Multiplex. Prescription pain medications can also be needed in Mononeuritis Multiplex.
Anticonvulsants such as phenytoin, gabapentin or pregabalin can be prescribed for treating mononeuritis multiplex.
Antidepressants such as nortriptyline, amitriptyline or duloxetine can be prescribed to reduce the stabbing pain of Mononeuritis Multiplex.
Safety Measures in Mononeuritis Multiplex
It is important to look for safety measures in patients with Mononeuritis Multiplex, as they have movement or sensation difficulties. Decreased sensation and lack of muscle control in Mononeuritis Multiplex increases the risk of injuries or falls for the patient. Safety measures in Mononeuritis Multiplex consist of:
- Adequate lighting during the night.
- Use of railings on the stairs, in the bathroom etc.
- Testing the temperature of water before bathing.
- Removing obstacles such as furniture or loose rugs from the way to avoid tripping and falling.
- Always wearing protective shoes, which have no high heels or open toes.
- Always check your shoes for rough spots or grit to avoid injury to feet.
Patients with mononeuritis multiplex also suffer from decreased sensation, which is why they should always check their feet and other areas for open skin, bruises and other injuries which may have gone unnoticed. If these injuries are ignored, then they can get severely infected and cause further complications.
Patients suffering from mononeuritis multiplex are at increased risk for new injuries to the nerve, especially pressure points such as elbows and knees. So, the patients with mononeuritis multiplex should avoid pressure on these areas by not crossing the knees or leaning on the elbows.
What are the Complications of Mononeuritis Multiplex?
Given below are the following complications experienced in mononeuritis multiplex: Unnoticed or recurrent injury to any part of the body, atrophy, deformity, disturbances in the autonomic function of organs, psychological issues and other relationship issues associated with impotence.
What is the Prognosis of Mononeuritis Multiplex?
Patients can achieve complete recovery if the cause of mononeuritis multiplex is detected and successfully treated. However, the mononeuritis multiplex is prone to recur after a gap of some months or years.