title: Cephalic tetanus as a differential diagnosis of facial nerve palsy.
abstract: Cephalic tetanus is defined as a combination of trismus and paralysis of one or more cranial nerves. Since it is a rare cause of facial nerve palsy, it is often overlooked as a differential diagnosis. We present the case of a 75-year-old man admitted to our emergency department with left facial nerve palsy, left ptosis and dysphagia 2 weeks after a head laceration. Soon after admission, he was orally intubated because of massive aspiration. A delayed diagnosis of cephalic tetanus was reached only when he was extubated and trismus and risus sardonicus were identified in addition to facial nerve palsy. The patient was re-intubated and successfully extubated on day 20 postadmission. In orally intubated patients, trismus and risus sardonicus may be overlooked, and although rare, cephalic tetanus should be considered to be a differential diagnosis of facial nerve palsy.
authors.affiliation: Department of Critical Care Medicine, Japanese Red Cross Society Wakayama Medical Center, Wakayama, Japan.
authors.forename: Yuki
authors.identifier: http://orcid.org/0000-0002-9532-2859
authors.initials: Y
authors.lastname: Kotani
authors.affiliation: Department of Infectious Diseases, Japanese Red Cross Society Wakayama Medical Center, Wakayama, Japan.
authors.forename: Kenji
authors.initials: K
authors.lastname: Kubo
authors.affiliation: Department of Infectious Diseases, Japanese Red Cross Society Wakayama Medical Center, Wakayama, Japan.
authors.forename: Satoko
authors.initials: S
authors.lastname: Otsu
authors.affiliation: Department of Critical Care Medicine, Japanese Red Cross Society Wakayama Medical Center, Wakayama, Japan.
authors.forename: Toshihide
authors.initials: T
authors.lastname: Tsujimoto
mesh_terms: D000058:Accidental Falls; D000368:Aged; D057210:Delayed Diagnosis; D003937:Diagnosis, Differential; D004660:Encephalitis / Q000175:diagnosis; D005155:Facial Nerve Diseases / Q000175:diagnosis* / Q000209:etiology; D005158:Facial Paralysis / Q000175:diagnosis* / Q000209:etiology; D006801:Humans; D022125:Lacerations; D008297:Male; D008581:Meningitis / Q000175:diagnosis; D012535:Scalp / Q000293:injuries; D020521:Stroke / Q000175:diagnosis; D013742:Tetanus / Q000150:complications / Q000175:diagnosis*; D014313:Trismus / Q000175:diagnosis* / Q000209:etiology