Cephalic Tetanus: case report of a rare complication of orbito-ocular injury in a Nigerian
To highlight the risk of cephalic tetanus resulting from penetrating orbital injury.
To alert ophthalmologists to the importance of ensuring adequate anti-tetanus prophylaxis in all cases of ophthalmic and in particular orbital trauma most especially where foreign body retention is involved or is likely.
Methodology: A case of cephalic tetanus in a 24-year old Nigerian motor mechanic; presenting with torticollis, trismus, facial and neck muscle spasms and multiple cranial nerve palsies affecting the IIIrd, IVth, Vth and VIIth cranial nerves is reported. This followed a penetrating injury to the left orbit with a retained metallic foreign body. The patients anti-tetanus immunization status was not known prior to the injury. The patient developed symptoms of cephalic tetanus some days after receiving the anti-etanus serum intramuscularly. He was treated vigorously with anti-tetanus serum, intravenous diazepam and fluids, intravenous metronidazole and other parenteral broad- spectrum antibiotics. He was also actively immunized with tetanus toxoid injections.
Results: He made a slow but remarkable recovery after about five weeks (38 days) with minimal neurological deficit.
Keywords: cephalic tetanus, orbital injury, cranial nerves, anti-tetanus prophylaxis, occupational hazzard
Nigerian Journal of Ophthalmology Vol. 13 (1) 2005: 32-35