Ophisthotimonus
Case history:
13 yr old boy with injury to left leg a week ago while playing in the park.
What infection❓️
Condition ❓️
Treatment ❓️
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| Tetanus details |
Explanation:
OPISTHOTONUS DUE TO TETANUS
Pathophysiology of generalized tetanus involves colonization of a wound by Clostridium tetani, anaerobic spore-forming Gram-positive rod found in soil & feces. C. tetani produces Tetanospasmin, a potent neurotoxin that inhibits the release of glycine & GABA, leading to muscle spasm Nerves of face and neck are affected first due to their short axon length, followed by trunk and extremities.
Risus sardonicus or “sardonic grin”
Sustained facial muscle contraction is known as risus sardonicus or “sardonic grin” and is often earliest sign of acute tetanus. Severe truncal hyperextension & spasticity, known as opisthotonos, is a nearly universal late finding that occurs due to difference in the relative strength of the strong extensor muscles of axial spine compared with weak flexor muscles ofabdomen.Explanation for patient’s sustained tetany in spite of weight-appropriate dosing of a neuromuscular blocking agent is unknown; however, it is possible that upregulation of post-synaptic acetylcholine receptors and poor perfusion secondary to hypotension and critical illness played a role.
Differential diagnosis for patients who present with opisthotonos
Differential diagnosis for patients who present with opisthotonos includes strychnine poisoning, traumatic brain injury, cerebral palsy, dystonic medication reaction, drowning, and maple syrup urine disease.
