title: [Dysfunction of multiple cranial nerves in cephalic tetanus--case report].
abstract: A 77-year-old man non-immunized to tetanus suffered head trauma on the right side when he tumbled from a height of approximately 2m. Five days later, he experienced difficulty in opening his mouth and developed right ptosis. He was referred to our hospital 2 days post-ictus. The patient suffered trismus, and developed right Horner's syndrome with in a week. Symptoms due to multiple cranial nerve palsies were observed: right inferior oblique muscle weakness, reduced right corneal reflex, right facial palsy, dysphagia, and abnormal tongue movements. Neuroimages (computed tomography, magnetic resonance imaging, and angiography) of the basal skull and internal carotid arteries revealed no abnormalities. From the symptoms associated with his infected head wound and clinical follow-up, we suggested that he had cephalic tetanus. We subsequently conducted the following treatments: debridement of the wound, intravenous infusion of antitetanus human immunoglobulin (AHI), intrathecal AHI infusion, and systemic administration of benzylpenicillin. His condition improved with these treatments, and without any complications such as autonomic nervous system dysfunction or classical tetanic spasms. This case suggests that we should consider the possibility of cephalic tetanus when we observe a patient with cranial nerve palsy associated with injury.
authors.affiliation: Department of Neurosurgery, Nakano General Hospital.
authors.forename: Mutsumi
authors.initials: M
authors.lastname: Fujii
authors.forename: Mitsuhiko
authors.initials: M
authors.lastname: Hokari
authors.forename: Akiko
authors.initials: A
authors.lastname: Yokoyama
authors.forename: Hiroki
authors.initials: H
authors.lastname: Miyashita
authors.forename: Akiko
authors.initials: A
authors.lastname: Ishihara
authors.forename: Taro
authors.initials: T
authors.lastname: Fujikawa
mesh_terms: D000058:Accidental Falls; D000368:Aged; D000900:Anti-Bacterial Agents / Q000008:administration & dosage; D003389:Cranial Nerve Diseases / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D003646:Debridement; D016489:Head Injuries, Closed / Q000150:complications*; D006732:Horner Syndrome / Q000175:diagnosis / Q000209:etiology / Q000628:therapy; D006801:Humans; D008297:Male; D010400:Penicillin G / Q000008:administration & dosage; D013742:Tetanus / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D013743:Tetanus Antitoxin / Q000008:administration & dosage; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents; D013743:Tetanus Antitoxin; D010400:Penicillin G