Cephalic tetanus presenting as facial palsy, ptosis, trismus, and orthopnea following a fall

Abstract

Tetanus is a bacterial infection of the nervous system caused by neurotoxins produced by Clostridium tetani. Cephalic tetanus is a rare, localized form of the disease that is often under-recognized and misdiagnosed. Patients typically present with cranial neuropathies, trismus, and stiffness localized to the head and neck. Early recognition of the disease is crucial, as it is easily treatable and can prevent progression to the more severe generalized form. In this report, we describe a patient who developed progressive neurological symptoms after sustaining a forehead laceration from a fall. Over the course of three weeks, he developed facial (VII) nerve palsy, ptosis, followed by trismus, and later orthopnea, which are uncommon manifestations of the disease. This case underscores the importance of early recognition, treatment, and prevention of this neglected condition, which is not commonly observed in well-developed healthcare systems where immunization is universally available.