A retrospective evaluation of neurological, neuroradiological, neurophysiological, psychological, and laboratory findings on 37 patients, remitted to the Institute of Occupational Health, Helsinki because of suspected poisoning due to organic solvents, was performed. Patient selection was made on the basis of performed pneumoencephalography (PEG). Most of the patients had been exposed to a mixture of solvents (19 cases). Carbon disulphide exposure had occurred in six cases, trichloroethylene in five cases, and the rest of the patients had been exposed to styrene (one case), thinner (two cases), toluene (1 case), methanol (1 case), and carbon tetrachloride (two cases). Clinical neurological findings comprised slight psycho-organic alteration, cerebellar dysfunction, and peripheral neuropathy. The PEG showed changes suggesting brain atrophy in 63% of the patients. Slight asymmetric central atrophy and localized cortical atrophy were the most frequent findings. The main electroencephalographic finding was slight diffuse slow-wave. Electroneuromyography showed slight changes suggesting peripheral neuropathy in 23 of the 28 patients examined. Psychological alterations were seen in all patients: personality changes and psychomotor disturbances were the most common findings. Because individual constitutional differences existed, no clear-cut exposure-effect relationship could be established. Thus, neurological evaluation of all those exposed to neurotoxic agents who present symptoms, regardless of the degree of current exposure, is important.

SUMMARY Five children aged five to 15 years contracted tetanus in Finland between 1969 and 1985, together with 101 adults. Four of the five had been adequately immunized against tetanus. The clinical picture of tetanus was mild or moderate, and none of the children needed respirator treatment. Epilepsy, meningitis and psychogenic symptoms were considered in the differential diagnosis. The course of tetanus in immunized patients is atypical and often benign, but the diagnosis is problematic‐in contrast to affected children in developing countries, whose populations are not adequately immunized and where neonatal tetanus is common and often fatal.

From 1969-1985, 106 people contracted tetanus in Finland. The outcome of the disease was good in 78 cases (returned to work), poor in 27 (12 died, 5 institutionalized and 10 retired) and unknown in 1. Poor outcome was the result of a disease requiring respirator treatment. Other clinical factors significantly correlated with poor outcome were blood pressure lability, hyperglycemia, hyperthermia, tachycardia and anticoagulation therapy. Forty people who were representative of the whole series with regard to sex, age and severity of disease attended a follow-up study on average 7 years and 4 months later. Forty age- and sex-matched controls had the same examinations, and compared with them, the 40 patients still had significantly more muscle fatigue and cramps, nervousness, decreased mental capacity and difficulties in balance, speech and memory. They also had more clinical findings, such as peripheral paresis, muscular atrophy, decreased or absent tendon reflexes and decreased mental capacity than the controls.

During the period 1969-85, tetanus caused the hospitalization of 106 patients (63 men and 43 women) in Finland. 12 (11.3%) of them died, most of the causes of death being unexpected complications during the intensive care. The majority of the patients were more than 50 years old and had not been fully vaccinated against tetanus. There was a clear seasonal variation, most of the cases occurring during the months when there is no snow on the ground. Half of the primary lesions were minor injuries to hands and fingers. Only half of the primary lesions had needed medical treatment and usually the patients had received antibiotics and tetanus vaccination but not immunoglobulin. To diagnose tetanus is more difficult today than previously, because few doctors nowadays encounter tetanus cases and the diagnosis is based entirely on clinical criteria, and because abortive mild forms of tetanus may occur, especially in patients with partial immunity.

In a 16-year nationwide study in Finland 106 patients were diagnosed as having tetanus. Tetanus was diagnosed on the first visit to a doctor in half the patients, it was suspected in 28% but not considered in 22%. Diagnosis of tetanus may be delayed if a patient is elderly or has no known primary lesion. Abnormal EEGs and CSF findings with increased protein level were unexpectedly common (76% and 24% respectively). The most significant complications were cardiac arrhythmias (34%), blood pressure lability (32%), an increased haemorrhagic tendency (28%), an increase in thrombosis (8%) and/or of anoxic periods (16%) and death (11%). Intensive care has markedly improved the prognosis of tetanus; the main problems at present are difficulty of early diagnosis and treatment of complications of the most serious cases.