Cephalic tetanus manifesting as isolated facial nerve palsy- a case report from rural Armenia

Cephalic tetanus is a rare clinical form of tetanus, clinically characterized by trismus and cranial nerve palsy involving one or more cranial nerves, facial nerve being the most common. We report a case of cephalic tetanus with left-sided lower motor facial nerve palsy in a 66-year-old non-immunize...

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Bibliographic Details
Published in:Journal of infection in developing countries 2021-11, Vol.15 (11), p.1770-1773
Main Authors: Kishmiryan, Armen, Gautam, Jeevan, Acharya, Deeksha, Singh, Bishnu Mohan, Ohanyan, Armen, Arakelyan, Anna, Vahanyan, Anush, Shoura, Sami
Format: Article
Language:English
Subjects:
Aged
Anti-Bacterial Agents - administration & dosage
Armenia
Bell Palsy - diagnosis
Bell's palsy
Case reports
Diagnosis, Differential
Face
Facial Paralysis - etiology
Humans
Male
Medical diagnosis
Metronidazole - administration & dosage
Neurological disorders
Rural Population
Tetanus
Tetanus - complications
Tetanus - diagnosis
Tetanus - drug therapy
Trismus - etiology
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Summary:Cephalic tetanus is a rare clinical form of tetanus, clinically characterized by trismus and cranial nerve palsy involving one or more cranial nerves, facial nerve being the most common. We report a case of cephalic tetanus with left-sided lower motor facial nerve palsy in a 66-year-old non-immunized patient after an untreated laceration injury. The patient had dysphagia, spasm of the muscles of mastication, asymmetry of the left side of the face, cough, shortness of breath, and stiffness of neck muscles. The presentation was unique given that the facial nerve palsy appeared prior to the occurrence of trismus, which misled the initial diagnosis towards Bell's palsy. He was successfully treated with tetanus antitoxin without any adverse events. Although widespread use of tetanus vaccine has led to a dramatic decline in this fatal disease, sporadic disease occurrence is still possible, particularly in individuals without up-to-date vaccinations. In this case report we illustrate the importance of early recognition of cephalic tetanus prior to the development of the full clinical picture. The early initiation of therapy is the key to recovery from this deadly disease. Physicians are encouraged to include cephalic tetanus as a cause of facial nerve palsy in their differential. In particular, paying attention to cases manifesting early after head or neck injury.
ISSN:1972-2680
2036-6590
1972-2680
DOI:10.3855/jidc.13817