E-Pearl of the Week: Cephalic Tetanus

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March 25, 2013

Cephalic tetanus is a rare variant of localized tetanus that is accompanied by cranial nerve palsy. The condition was originally called tetanus hydrophobicus. Cranial neuropathy may precede the manifestations of tetanus, and tetanus may remain limited to the craniofacial musculature. The facial nerve is most commonly affected followed by oculomotor and hypoglossal nerves. Presynaptic blockade of acetylcholine release caused by locally accumulated tetanus toxin at the neuromuscular junction is the probable pathogenesis.


  1. Schon F, O'Dowd L, White J, Begg N. Tetanus: delay in diagnosis in England and Wales. J Neurol Neurosurg Psychiatry. 1994; 57: 1006-1007.
  2. Jagoda A, Riggio S, Burguieres T. Cephalic tetanus: a case report and review of the literature. Am J Emerg Med 1988; 6:128-130.

Submitted by Rajeev Nayak, Resident G.B. Pant Hospital, J.L.N. Marg

Disclosure: Dr. Nayak reports no disclosures.

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