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Cephalic Tetanus: case report of a rare complication of orbito-ocular injury in a Nigerian

OA Ogun
AO Ashaye
SO Ola



• 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 patient’s 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

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eISSN: 2468-8363
print ISSN: 0189-9171