Overview
Inflammatory damage to a single peripheral nerve, such as facial neuritis, brachial plexus neuritis, lateral femoral dermatitis, sciatic neuritis, etc. can occur in the distribution area of the affected nerve pain; sensory loss, loss of sensation; muscle weakness, paralysis; skin pallor, roughness, etc. Mainly associated with autoimmune response, infection, poisoning, metabolism, ischemia and other etiological factors rely on the causes of the disease treatment, treatment of the symptoms of the treatment, drug therapy based on the combination of rehabilitation Traditional Chinese Medicine (TCM)
Definition
Mononeuritis refers to inflammatory damage to a single nerve or nerve trunk caused by various reasons.
The so-called “inflammatory damage” refers to the pathological manifestations of the diseased nerve, which may be caused by inflammation, infection, poisoning, metabolic abnormality, trauma, compression, blood transport disorders and so on.
Sensory, motor and autonomic dysfunction can occur in the damaged innervated area, which is manifested as sensory loss and disappearance; muscle paralysis and atrophy; and pale and rough skin.
These nerve damages can either occur singly in a certain nerve, such as facial neuritis, brachial plexus neuritis, lateral femoral dermatitis; or they can involve multiple independent nerves, which is called multiple mononeuritis, such as secondary to rheumatic polyarteritis.
This article focuses on single mononeuritis; for multiple mononeuritis, see Multiple peripheral neuritis.
Classification
Classification by nerve type
Cerebral nerves: inflammatory lesions occur in the cerebral nerves (cranial nerves), e.g. retrobulbar optic neuritis, facial neuritis, trigeminal neuritis, glossopharyngeal neuritis.
Spinal nerves: inflammatory lesions occur in the spinal nerves, such as brachial plexus neuritis, lateral femoral dermatitis, radial nerve damage, sciatic nerve damage, etc.
Prevalence
There are no authoritative statistics on the overall prevalence of mononeuritis, taking the common types as an example:
The incidence rate of facial neuritis is 11.5-53.3/100,000, and it can occur at any age, mostly in 20-40 years old, more men than women, and most of them have unilateral onset. A small number of patients may have recurrent episodes, with a recurrence rate of 2.6% to 15.2%.
The incidence rate of brachial plexus neuritis is 1‰, which can occur at any age, mostly in 20-40 years old.
The prevalence of lateral femoral dermatomyelitis is about 32.6 per 100,000 people and is most common in more obese men aged 20 to 50 years.
The prevalence of sciatica varies between 1.2% and 43%, with a significantly higher incidence in developing countries.
Causes
Causes
The causes of mononeuritis are divided into systemic and localized causes, and it is difficult to find the exact cause of some cases of mononeuritis.
Systemic causes
These include infections, autoimmune reactions, poisoning, nutritional disorders, metabolic disorders, and systemic vascular lesions.
Infection: e.g. Guillain-Barré syndrome, viral infection, etc.
Autoimmune reaction: such as lupus erythematosus, tuberculosis, polyarteritis nodosa and rheumatoid arthritis and other diseases, serum or after vaccination.
Poisoning: such as isoniazid, furan drugs, phenytoin sodium and other drug poisoning; organophosphorus pesticides, hexane and other chemicals; lead, arsenic, mercury and other heavy metal poisoning.
Nutritional disorders: common B vitamin deficiencies, chronic alcoholism, chronic gastrointestinal diseases or post-surgery.
Metabolic disorders: such as porphyria, diabetes mellitus, uremia, amyloidosis, gout, hypothyroidism, acromegaly and so on.
Systemic vascular lesions: e.g., atherosclerosis.
Localized etiology
Including trauma, compression, tumor, blood transport disorders, etc.
Trauma: e.g. fracture dislocation, firearm injury, pulling, extrusion.
Compression: can be caused by nearby tumors and occupations, such as lung cancer, lymphoma, cysts and so on.
Blood transportation obstacle: local blood vessels become narrow and occluded, causing nerve ischemia.
Triggering factors
Cold, cold, flu, fatigue, insomnia, blood sugar fluctuation and other factors can induce or aggravate the disease.
High risk groups
People with the following conditions or factors belong to the high-risk group of this disease:
Elderly people.
People with nutritional and metabolic diseases.
People with long-term exposure to toxic and hazardous substances.
People with low immunity.
Symptoms
Sensory, motor and autonomic dysfunction can be seen in the affected innervated area. Symptoms can occur simultaneously or be dominated by certain symptoms.
Pain
The typical symptom is radiating pain along the affected nerve course. That is, the pain is not only localized in the lesion, but also radiates to other areas.
For example, in sciatic nerve injury, pain radiates from the lower back and buttocks to the back of the thigh, the back and outside of the calf and the outside of the foot.
The pain is often a persistent dull ache that worsens in paroxysms; it may also be electric shock, cutting or burning pain.
Sensory disturbances
Hyperalgesia: the skin is not responsive to pins and needles, heat and cold, or even disappears.
Sensory hypersensitivity: the skin is hypersensitive to touch, temperature and other stimuli, or even severe pain.
Sensory abnormality: numbness, over electric sensation, ants sensation; or burning or pins and needles pain.
Movement disorder
Weakness, flaccidity, atrophy, muscle fasciculation, deformity of appearance of the affected innervated muscles.
For example, facial neuritis may present with paralysis of the facial expression muscles on the affected side, disappearance of frontal lines, inability to wrinkle the forehead and furrow the eyebrows, and inability to close the eyelids or incomplete closure.
Brachial plexus neuritis can appear upper limb can not be lifted, elbow joint can not be flexed, flexion of the wrist and grip weakness.
Sciatic nerve injury may present with muscle weakness and atrophy in the buttocks, calves, and feet, and claudication (walking with a limp).
Autonomic dysfunction
Pale, cold skin, decreased skin temperature.
Rough, thin, sweatless skin.
Finger (toe) nails lose their normal luster.
Complications
Horner’s syndrome
Brachial plexus injury can lead to Horner’s syndrome on the ipsilateral side.
It is characterized by miosis, ptosis, inversion of the eyeballs, and little or no facial sweating.
Joint contractures and deformities
Caused by muscle weakness, limited joint movement, and prolonged immobilization.
This is characterized by stiffness of the tissues around the joints, inability to move on their own, and deformity.
Swelling of the limbs
Circulatory disorders due to inactivity or low muscle tone and vascular dysfunction.
This is characterized by swelling of the limbs, coldness, depression when pressed and difficulty in rebounding, most obvious in the hands and feet.
Consultation
Department of Medicine
Neurology
For symptoms such as loss of sensation in the face and limbs, muscle weakness, paralysis, and pale, rough skin, consult a doctor promptly.
Neurosurgery
If the above symptoms appear after a trauma, you can consult the neurosurgery department.
Due to the various causes of the disease, the patient’s first department may also be endocrinology, orthopedics, hand surgery, oncology and so on.
Preparation
Consultation: registration, preparation of documents, common problems
Tips for medical treatment
Try to keep a record of the symptoms you have experienced and how long they have lasted, so that you can give your doctor more information.
Preparation Checklist
Symptom list
Pay particular attention to the time of onset of symptoms, special manifestations, etc.
Are there any symptoms such as pain, loss of sensation, numbness, etc. in the face or limbs?
Are there any symptoms such as muscle weakness, paralysis, or muscle atrophy of the face or limbs?
Are there any symptoms such as localized skin pallor, roughness, loss of normal luster of finger (toe) nails, etc.?
When did the symptoms first appear and how long did they last?
Where did the symptoms first appear and did they progress?
Any aggravating or relieving factors?
List of medical history
Has there been any long-term medication, exposure to pesticides, chemicals, heavy metals, etc.?
Any nutritional disorders such as B vitamin deficiency, chronic alcoholism?
Are there metabolic disorders such as diabetes, uremia, etc.?
Any recent vaccinations, serum use?
Are there autoimmune diseases, such as systemic lupus erythematosus?
Are there systemic or localized vascular diseases, such as atherosclerosis, localized vascular occlusion?
Any traumatic injuries, e.g., strains, crush injuries?
Any tumors, occupations, such as lung cancer, lymphoma, cysts?
Checklist
Examination results in the last six months, which can be brought to the doctor’s office
Electromyography (EMG) of the lesion site, magnetic resonance imaging (MRI)
Laboratory tests: blood routine, blood biochemistry (liver and kidney function, blood lipids, blood glucose, electrolytes), rheumatoid factor, anti-nuclear antibody, double-stranded DNA antibody, liver and kidney function, serum vitamin B1 level.
Medication List
Medication used in the last 3 months, if there is a box or package of medication, you can bring it with you to the doctor’s office
Neurotrophic drugs: B vitamins, methylcobalamin, rat nerve growth factor.
Painkillers: indomethacin, ibuprofen, gabapentin, pregabalin, carbamazepine, etc.
Glucose-lowering drugs: metformin, glimepiride, acarbose.
Diagnosis
Diagnosis is based on
Medical history
The patient may have had long-term medication or exposure to toxic or harmful substances.
May have suffered from nutritional diseases, metabolic diseases, autoimmune diseases, systemic or local vascular diseases, tumors, or space-occupying diseases.
The patient may have recently received vaccination, used serum or suffered trauma.
Clinical manifestations
Symptoms
Loss of sensation in the face and limbs, muscle weakness, paralysis, pale and rough skin.
Physical signs
The doctor uses physical examination to find out if there are any abnormalities in muscle strength, skin sensation, autonomic function and nerve reflexes.
Facial movement examination: Cooperate with the doctor to complete a series of movements and tests, such as wrinkling the forehead, opening and closing the eyes, puffing out the cheeks, swallowing, etc., to determine whether the facial nerve function is impaired.
Limb Muscle Strength Examination: Judge the muscle strength by lifting hands, legs, walking and other movements.
Skin Sensory Examination: Evaluate the sensitivity of skin sensation through light touch, pinprick and hot/cold stimulation.
Skin autonomic function examination: determine whether the skin is smooth, how warm it is, and whether there is sweat by observing and touching the skin.
Tendon reflex examination: observe the contraction of wrist and calf muscles when tapping the forearm and Achilles tendon. There will be weakening or loss of muscle contraction in this disease.
Examination tests
Laboratory tests
Purpose of examination: to clarify the cause of the disease and the patient’s general condition.
Common items: blood routine, liver and kidney function, blood sugar, electrolytes, C-reactive protein, blood sedimentation, tumor factor, immunofixation electrophoresis, serum vitamin B1 level, etc.
Precautions: Most of the items require fasting and need to be rechecked in the course of treatment.
Neurophysiologic examination
Including sensory/motor evoked potentials, electromyography, skin sympathetic response measurement.
Purpose: To discover the type and extent of peripheral nerve damage.
Results: There may be a slowing down of nerve signal conduction and a decrease in voltage; disappearance or delayed appearance of muscle response to stimuli, suggesting that there is damage to the peripheral nerves and a decrease in the number and ability of muscle fiber contraction.
Examination precautions: Before the examination, the skin should be cleaned and relaxed according to the doctor’s requirements. Avoid skin dirt and mental tension to affect the examination result.
Imaging examination
Including CT and MRI of the cranium and lesion area.
Purpose: To confirm whether there are tumors, occupations and other lesions in the skull and around the lesion nerves.
Note: MRI shows tumors and brain tissue more clearly than CT. However, CT can detect localized fractures, dislocations and other traumatic conditions.
Differential diagnosis
Different types of mononeuritis need to be differentiated from different diseases, taking the common facial neuritis, brachial plexus neuritis and sciatic nerve injury as examples:
Guillain-Barré syndrome
Facial neuritis needs to be differentiated from Guillain-Barré syndrome.
Similarities: Both present with peripheral facial paralysis.
Differences: Guillain-Barré syndrome is characterized by bilateral facial paralysis with extensive involvement. Symmetrical limb weakness and sensory deficits may be present, and there is characteristic protein-cell separation on cerebrospinal fluid examination.
Thoracic outlet syndrome
Brachial plexus neuritis needs to be differentiated from thoracic outlet syndrome.
Similarities: both involve severe pain in the scapular girdle, which may extend to the elbow and forearm.
Differences: Thoracic outlet syndrome is associated with shoulder and arm pain, worsening of symptoms with lifting or carrying of the upper arm, triggering of symptoms or hypokinesia with continuous rapid fist-clenching motions over the upper extremity, poor localization of pain, and lack of a typical radicular distribution.
Fibrositis of the buttocks
Sciatic nerve injury also needs to be differentiated from gluteal fibrositis.
Similarities: both have pain in one side of the buttock and lower extremity.
Differences: gluteal fibrositis pain, pressure pain is limited to the buttock without spreading; there is no sensory impairment, muscle weakness and other symptoms; ankle reflexes are not abnormal.
Treatment
Treatment objective: to reduce pain, improve symptoms, and improve patients’ quality of life.
Treatment principle: Early diagnosis, treatment for the cause and symptoms, mainly drug treatment with rehabilitation therapy.
Drug treatment
Neurotrophic drugs.
Therapeutic purpose: improve nerve nutrition, promote nerve function recovery.
Indications: applicable to the protection of nerves in the acute stage and auxiliary treatment after surgery.
Commonly used drugs: vitamin B6, vitamin B12, methylcobalamin, murine nerve growth factor and so on.
Adverse reactions: vitamin B1, nausea, vomiting, skin rash may occur.
Glucocorticoid
Purpose: anti-inflammatory, regulate immune response.
Commonly used drugs: prednisone, methylprednisolone, dexamethasone and so on.
Cautions: Long-term use may cause problems with blood sugar, dyslipidemia, blood clots, osteoporosis, and spread of infection. Use with caution in patients with diabetes, osteoporosis, cirrhosis, renal insufficiency, hypertension, thrombosis, psychosis, glaucoma, tuberculosis, and infections.
Anti-infection treatment
Purpose: Anti-inflammatory, anti-infection, anti-virus.
Commonly used drugs: acyclovir, ceftazidime, etc.
Adverse reactions: occasional dizziness, headache, arthralgia, nausea, vomiting, diarrhea, stomach upset, loss of appetite, thirst, leukocyte drop, proteinuria and urea nitrogen mildly elevated, itching of the skin, etc. Acne, insomnia, menstrual disorders are occasionally seen with prolonged administration.
Other drugs
Analgesic drugs: the main drugs to relieve neuralgia. Such as carbamazepine, pregabalin, gabapentin, amitriptyline and so on.
Diabetic patients can use insulin, metformin, repaglinide and other drugs to control blood sugar.
Chronic alcoholism needs to standardize the abstinence from alcohol, nalmefene, naloxone, naltrexone and other drugs can be used to reduce the patient’s dependence on alcohol.
Drug-induced people need to stop and change drugs as soon as possible under the guidance of a doctor.
Surgery
Indications: If the lesion is caused by nerve compression; or the lesion is so serious that the nerve function is difficult to restore, surgical treatment can be considered.
Commonly used modalities: nerve release surgery, nerve transposition surgery, autologous nerve transplantation, and so on.
Precautions: Surgery carries its own risks, and complications such as incomplete release, postoperative wound infection, scar formation, nerve or blood vessel injury may occur after surgery; after surgery, it is necessary to restrict local joint activities and pay attention to the prevention of infection, so as not to affect the healing of the wound.
Rehabilitation
Muscle strength training
For areas with very poor muscle strength and inability to move actively, centripetal massage and passive joint movement can be performed to prevent muscle atrophy, maintain joint mobility and prevent joint adhesion.
For areas that retain some active movement ability, active muscle contraction, assisted movement and resistance exercise should be performed.
Sensory training
The main focus is to apply tactile stimulation to the skin, such as nociceptive stimulation, tactile stimulation, ice-warm water alternating temperature stimulation, and tactile screening of physical objects.
Occupational therapy
Conduct appropriate daily life movement training, such as dressing and undressing, eating, knitting, typing, carpentry, etc., to improve independent living function.
Orthotics and assistive devices
Maintain the joints of the injured part in the proper position and keep them in the functional position to prevent injury.
Such as wrist support, shoulder sling, brace, splint, etc.
Physical factor therapy
Through infrared therapy, laser therapy, induction electrotherapy and other treatments, it can achieve the purpose of promoting nerve repair, relieving pain and preventing joint adhesion.
Transcutaneous electrical nerve stimulation and neuromuscular electrical stimulation therapy are used to promote nerve regeneration and functional recovery.
Traditional Chinese Medicine (TCM)
The principle of Chinese medicine treatment mainly focuses on benefiting qi and activating blood circulation, resolving blood stasis and clearing up collaterals.
The treatment methods include soups, patent medicines, acupuncture, herbal fumigation, acupoints dressing and so on.
It mainly includes acupuncture combined with intramuscular efficacy patch therapy, and proprietary Chinese medicines such as Dawuoluodan, Xiaowuoluodan, and Shufengding Pain Pill.
Prognosis
Cure
Mononeuritis belongs to peripheral nerve disease, which has some spontaneous repair ability, but the recovery speed is relatively slow, most patients need 3-6 months. The prognosis of this disease mainly depends on the primary disease and the duration of the disease.
Acute lesions caused by poisoning, vitamin B deficiency, and infection have partial or complete recovery of nerve function after removal of the cause.
Recovery from brachial plexus neuritis is slow, taking months to years, and many patients may be left with residual pain and decreased motor endurance of the affected limb.
Irreversible neurologic dysfunction often occurs with tumor-related or long-term autoimmune diseases, genetic disorders, or metabolic disorders.
Hazards
Peripheral facial paralysis left behind by facial neuritis affects aesthetics and interferes with eating.
Weakness of limbs, joint contractures, and paralysis lead to prolonged bed rest, resulting in a serious decline in quality of life.
Due to reduced or absent skin sensation, accidents such as skin breakouts, burns and scalds are prone to occur.
Remaining irreversible disabilities can bring huge psychological barriers, cause psychological diseases, and increase the burden on family and society.
Daily
Daily Management
Diet management
Balanced diet, increase nutrition, ensure sufficient nutrition and appropriate weight.
Eat more food rich in vitamin B, such as liver, fish, meat, whole grains, nuts, beans and egg yolk.
Diabetic patients avoid high sugar foods to ensure stable blood sugar.
Do not smoke or drink alcohol.
Exercise management
Choose suitable exercise methods under doctor’s advice, such as Baduanjin, Taiji, paper-cutting and clay modeling.
Exercise should pay attention to a safe environment, gradual progress and appropriate intensity.
Life Management
Pay attention to rest and avoid exertion.
If the brace is used for a long time, it should not be fixed too tightly and should be unfastened regularly to observe the skin condition and avoid skin injury.
The lesion area may show pallor and coldness, attention should be paid to keep warm, but prohibit the use of hot water bags, warm babies and other items with high local heat to avoid burns.
Patients with eyelid closure insufficiency should wear eye protection to protect the cornea and avoid causing eye diseases.
Bathe regularly, do not use too hot water when bathing, and do not rub or friction the skin too hard when cleaning to prevent injury.
Psychological support
Patients may experience emotional instability, irritability and depression due to slow recovery. Family members should actively communicate with patients and provide positive emotional value.
If necessary, seek help from professional psychological practitioners.
Disease monitoring
Monitor changes in muscle strength, sensation and skin condition.
Changes such as localized skin redness, blistering, and purpling should be taken seriously.
Those with diabetes should monitor blood glucose.
Follow-up
Follow the doctor’s instructions for regular review, usually once every 1 to 3 months, in order to adjust the treatment program.
Follow-up examinations include laboratory tests and electromyography.
Prevention
Patients with this disease are mainly prevented against the cause of the disease:
Actively treat diabetes, rheumatoid arthritis, systemic lupus erythematosus, tumors and other diseases.
Do not drink alcohol, and quit drinking as soon as possible if you have the habit of drinking alcohol.
Avoid contact with toxic and hazardous substances, and take good occupational protection in related industries.