Diagnosis:
This is a clinical diagnosis supported by electrophysiological features
Clinical features:
Tetany: lockjaw (trismus), wrinkled forehead (frontalis), closed eyes (orbicularis oculi), retracted lips (resus sardonicus), contracted bulbar muscles, neck, limbs, rigidity, board-like abdomen
Spasms: opsotonos, paroxysms of contraction, pharyngeal/laryngeal spasms,
Diaphoresis, BP swings
Localised tetany: rigidity and spasms localised to one part of the body, near a wound. If localised to the head it’s called cephalic tetanus
Findings on investigations:
NCS/EMG:
- Spasm: Continuous discharges of normal motor units
- Loss of physiologic silent period after contraction (50-100ms). Best found in masseter.
CK: normal or slightly raised
Treatment:
Antitoxin (tetanus immune human globulin)
Penicillin 10days, Metronidazole or tetracycline
Treatment of the wound
Support:
- Airway management
- Neuromuscular blocking agent
- Benzodiazepines