1/29. The silent period after magnetic brain stimulation in generalized tetanus.The cortical silent period has not previously been studied in tetanus. Transcranial magnetic brain stimulation in a patient with generalized tetanus revealed enlarged electromyographic (EMG) responses and absence or reduction of the late phase of EMG silence following the motor evoked potential in sternomastoid and biceps brachii muscles. Following clinical recovery, the silent period returned to normal. This observation is interpreted as evidence of impaired inhibitory mechanisms at multiple levels of the nervous system, including the cortex, in generalized tetanus.- - - - - - - - - - ranking = 1keywords = muscle (Clic here for more details about this article) |
2/29. tetanus-like syndrome secondary to metoclopramide administration.A case of metoclopramide-induced pseudotetanus in a 24-year-old woman is described. Symptoms included flexor spasms of the neck muscles, neck pain, left deviation of the lower jaw and tongue protrusion. tetanus was initially suspected. mydriasis, hyperhydrosis and clinical observation indicated that this syndrome could be caused by metoclopramide taken for gastrointestinal symptoms. orphenadrine hydrochloride, diazepam and ketoprofen completely resolved the symptoms. Pseudotetanus presents in many different ways, and it is sometimes very hard to distinguish it from infective tetanus, which is very difficult to diagnose. physicians using metoclopramide should be aware of its adverse effects and how to treat them.- - - - - - - - - - ranking = 1keywords = muscle (Clic here for more details about this article) |
3/29. A case of myositis ossificans as a complication of tetanus treated by surgical excision.myositis ossificans is a heterotopic ossification of skeletal muscles which is commonly seen after trauma. However, it is rarely seen as a complication of tetanus. We report a case of myositis ossificans following tetanus in a female adult patient presenting with ankylosis of both elbows in extension.- - - - - - - - - - ranking = 1keywords = muscle (Clic here for more details about this article) |
4/29. magnesium sulfate for control of muscle rigidity and spasms and avoidance of mechanical ventilation in pediatric tetanus.OBJECTIVE: To describe the use of intravenous magnesium sulfate for the control of muscle spasms and severe generalized rigidity in a child with moderate to severe tetanus without the need for prolonged deep sedation, mechanical ventilation, or neuromuscular blockade. DESIGN: Case report. SETTING: Pediatric intensive care unit in a tertiary care, university-based children's hospital. INTERVENTIONS: A continuous infusion of magnesium sulfate. MEASUREMENTS AND MAIN RESULTS: We describe a 12-yr-old child with moderate to severe tetanus who was treated with a continuous infusion of magnesium sulfate to control painful muscle spasms and severe generalized rigidity initially refractory to moderate sedation. Muscle spasms and severe generalized rigidity were improved with magnesium sulfate. No adverse effects associated with the use of magnesium sulfate were noted during the monitoring of cardiovascular and respiratory function, reflexes, and serum magnesium concentrations. CONCLUSIONS: An infusion of magnesium sulfate can be utilized to treat muscle spasms and severe generalized rigidity without the need for deep sedation, mechanical ventilation, or neuromuscular blockade. We recommend that magnesium sulfate be considered in the armamentarium of therapeutics utilized to treat muscle spasms and rigidity associated with tetanus, provided the patient's neurologic, cardiovascular, and respiratory status can be closely monitored in the pediatric intensive care unit.- - - - - - - - - - ranking = 15429.667437018keywords = rigidity, muscle (Clic here for more details about this article) |
5/29. tetanus and the plastic surgeon.tetanus in the united states is decidedly rare, and most of us will not see a case of it during our careers. Given its lethality, it is a disease about which one must be aware. Be willing to consider it as a diagnosis, no matter the immunization status of the patient, if clinical signs and symptoms warrant. To emphasize this point, the authors present a case of an otherwise healthy 41-year-old man who sustained electrical burns when he fell from a ladder and struck a power line on his way to the ground. He developed a compartment syndrome of his left leg at the exit site and subsequently underwent fasciotomies. When he later began to exhibit signs and symptoms of sepsis, his wound was debrided, and most of his anterior compartment was resected. Despite this, his condition worsened, and his clinical picture was suggestive of tetanus, including the classic findings of trismus, risus sardonicus, and opisthotonus. Using mechanical ventilation, paralysis, narcotics, and muscle-relaxing sedatives, the authors supported him until his tetany subsided. He survived and was discharged to home when complete coverage of his burns and left leg anterior compartment was obtained. The authors discuss the presentation, diagnosis, and treatment of tetanus, as well as its incidence in the general population and in the previously immunized patient.- - - - - - - - - - ranking = 1keywords = muscle (Clic here for more details about this article) |
6/29. Case report: diazepam in severe tetanus treatment.The causes of death in tetanus are muscle spasms and spasm of the larynx, which are caused by blocking the release of inhibitory neurotransmitters in the spinal synapses, causing the uncontrolled spread of impulses. diazepam controls the spasms by blocking the polysynaptic reflexes, working peripherally, without depressing the cortical center and has no cardiovascular or endocrine effects. High dose diazepam had been used and proved to be a good muscle relaxant. diazepam seems to work better with tetanus than pancuronium bromide, but both drugs need mechanical ventilation. In cases where the dose exceeds 240 mg per day in a child, a ventilator should be on hand, and if the dose required is more than 480 mg per day, other drugs should be considered. In three cases of severe tetanus presented here, the first two were managed by diazepam and pancuronium bromide and the last case by high dose diazepam only. In the first case, the dose of diazepam was up to 480 mg/day. By using high dose diazepam in severe tetanus, management of the clinical manifestations of autonomic nerve involvement and the weaning process become easier. Most complications of severe tetanus became more manageable.- - - - - - - - - - ranking = 2keywords = muscle (Clic here for more details about this article) |
7/29. tetanus in an unvaccinated child in the United Kingdom: case report.tetanus is a serious infectious disease that is associated with high morbidity and mortality. It is uncommon in developed countries like the United Kingdom due to widespread immunization. However, cases are still being reported in children who are not immunized. We report a case of an 8-year-old Asian boy who had missed his childhood vaccinations but had been living in the United Kingdom for 3 years. He presented with trismus and muscle spasms needing ventilation in Paediatric intensive care for 3 weeks. The case highlights the importance of vaccinating newly arrived children.- - - - - - - - - - ranking = 1keywords = muscle (Clic here for more details about this article) |
8/29. Dysphagia in tetanus: evaluation and outcome.A 72-year-old man who contracted tetanus after a puncture wound presented with severe dysphagia in association with trismus, risus sardonicus, and nuchal rigidity. We describe his medical course and outcome, including repeated videofluoroscopic barium swallow examinations. We emphasize the value of videofluoroscopy for examining and managing dysphagia in patients with tetanus, in both the acute and chronic stages of this rare illness.- - - - - - - - - - ranking = 1713.5186041131keywords = rigidity (Clic here for more details about this article) |
9/29. Vecuronium in the management of tetanus. Is it the muscle relaxant of choice?Two cases of severe tetanus admitted to ITU with muscle rigidity and convulsions and needed mechanical ventilation had a continuous infusion of vecuronium as muscle relaxant. The cardiovascular changes of the two patients are described. It is concluded that vecuronium because of its minimal cardiovascular effects is the relaxant of choice in the management of severe tetanus.- - - - - - - - - - ranking = 1719.5186041131keywords = rigidity, muscle (Clic here for more details about this article) |
10/29. Intravenous infusion of midazolam, propofol and vecuronium in a patient with severe tetanus.An adult patient with severe tetanus was successfully treated with alternating long-term infusions of propofol (20-80 mg/h, 8 3 days) and midazolam (5-15 mg/h, 29 days) for sedation, and with vecuronium infusion (6-8 mg/h, 35 days) for muscle relaxation. In addition, continuous infusion of labetalol (10-20 mg/h, 39 days) was given to control arterial blood pressure. Blood samples were taken daily for assays of propofol, midazolam and vecuronium plasma concentrations. No accumulation of propofol and vecuronium could be detected. There was an increase in liver enzyme activity at the end of the first 8-day propofol infusion. During the 4-week midazolam infusion, there were two marked plasma concentration peaks at times when the infusion rate was fairly stable. These changes coincided with pulmonary infection (c-reactive protein elevated) and ciprofloxacin treatment. The patient awoke rapidly after the last propofol infusion. He was unable to recall anything about his stay in the intensive care unit.- - - - - - - - - - ranking = 1keywords = muscle (Clic here for more details about this article) |
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