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NEUROLOGY 2008;70:e70
© 2008 American Academy of Neurology
Resident and Fellow Section

Video NeuroImage: Generalized tetanus in a 70-year-old woman

Formula

G. M. De Marchis, MD

From Ospedale Regionale di Locarno La Carità, Locarno, Switzerland.

Address correspondence and reprint requests to Dr. Gian Marco De Marchis, Ospedale Regionale di Locarno La Carità, 6600 Locarno, Switzerland gianmarcodemarchis{at}mac.com.

Three days before admission, a 70-year-old woman developed dysphagia. Examination revealed trismus and ulcers of the lower extremities due to chronic venous insufficiency. The following day the patient developed risus sardonicus (figure) and rigidity of the truncal muscles, but no opisthotonus (video). During the following weeks she developed autonomic dysfunction. We diagnosed generalized tetanus, most likely due to skin ulcers infected by Clostridium tetani. Treatment included mechanical ventilation, active and passive tetanus immunization, surgical debridement of the ulcers, and antibiotic therapy (metronidazole and imipenem/cilastatin). The outcome was favorable. The differential diagnosis of tetanus includes stiff-person syndrome, drug-induced dystonia, malignant neuroleptic syndrome, trismus due to dental infection, and strychnine poisoning. The diagnosis of tetanus is clinical. In clinical practice few attempts have been made to culture C tetani. It is difficult to culture, and C tetani may be present without disease in immunocompetent patients.1


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  		Figure Facial muscle contracture resulting in trismus and risus sardonicus

 

Supplemental data at www.neurology.org

Disclosure: The author reports no conflicts of interest.


   REFERENCE
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 REFERENCE
 

  1. Farrar JJ, Yen LM, Cook T, et al. Tetanus. J Neurol Neurosurg Psychiatry 2000;69:292–301.[Free Full Text]




This Article
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PubMed
Right arrow PubMed Citation
Right arrow Articles by De Marchis, G. M.
Related Collections
Right arrow Bacterial infections
Right arrow All Neuromuscular Disease
Right arrow Clinical neurology history
Right arrow Clinical neurology examination

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