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Cephalic tetanus as a differential diagnosis of facial nerve palsy

2017; BMJ; Linguagem: Inglês

10.1136/bcr-2016-216440

1757-790X

Yuki Kotani, Kenji Kubo, Satoko Otsu, Toshihide Tsujimoto,

Infectious Diseases and Tuberculosis

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.