Phrenic Nerve Palsy in Severe Tetanus

Panda, Nidhi; Yaddanapudi, Sandhya; Bharadwaj, Niteesh; Das, Chandi; Chari, Pramila

doi:10.1177/0310057x0403200220

Cited by 6 publications

(4 citation statements)

References 11 publications

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“…In moderate and severe tetanus, respiratory compromise develops because of chest wall muscle rigidity and spasm, diaphragmatic dysfunction, airway obstruction from laryngeal or glottal spasm, or aspiration pneumonia. 45,46 Episodes of cyanosis and apnoea are common in uncontrolled severe disease. Before mechanical ventilation and effective agents to control muscle spasm were available, tetanus mortality was mainly caused by respiratory failure.…”

Section: Clinical M a N I F E S T A T I O N Smentioning

confidence: 99%

Maternal and neonatal tetanus

Roper¹,

2007

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Maternal and neonatal tetanus are important causes of maternal and neonatal mortality, claiming about 180 000 lives worldwide every year, almost exclusively in developing countries. Although easily prevented by maternal immunisation with tetanus toxoid vaccine, and aseptic obstetric and postnatal umbilical-cord care practices, maternal and neonatal tetanus persist as public-health problems in 48 countries, mainly in Asia and Africa. Survival of tetanus patients has improved substantially for those treated in hospitals with modern intensive-care facilities; however, such facilities are often unavailable where the tetanus burden is highest. The Maternal and Neonatal Tetanus Elimination Initiative assists countries in which maternal and neonatal tetanus has not been eliminated to provide immunisation with tetanus toxoid to women of childbearing age. The ultimate goal of this initiative is the worldwide elimination of maternal and neonatal tetanus. Since tetanus spores cannot be removed from the environment, sustaining elimination will require improvements to presently inadequate immunisation and health-service infrastructures, and universal access to those services. The renewed worldwide commitment to the reduction of maternal and child mortality, if translated into effective action, could help to provide the systemic changes needed for long-term elimination of maternal and neonatal tetanus.

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Section: Clinical M a N I F E S T A T I O N Smentioning

confidence: 99%

Maternal and neonatal tetanus

Roper¹,

2007

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“…16 Unilateral or bilateral phrenic nerve palsy with diaphragmatic paralysis was reported by Panda et al in three patients with tetanus. 17 There are some case reports of diaphragmatic paralysis due to human immunodeficiency virus (HIV) and West Nile virus. 18,19 Myopathy related to acid maltase deficiency directly affects the diaphragm to cause paralysis.…”

Section: Traumatic 2 Compression Related 3 Inflammatory 4 Neuropatmentioning

confidence: 99%

Diaphragm Paralysis

Qureshi

2009

Semin Respir Crit Care Med

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The diaphragm is a chief muscle of inspiration. Its paralysis can lead to dyspnea and can affect ventilatory function. Diaphragmatic paralysis can be unilateral or bilateral. The clinical symptoms are more prominent in bilateral diaphragm paralysis. Ventilatory failure and cor pulmonale are usually seen in severe cases. Although an uncommon cause of dyspnea it still remains an underdiagnosed condition. A restrictive process is seen on pulmonary function tests in diaphragm paralysis. The symptoms, oxygenation and vital capacity, usually worsen in supine posture. The diagnoses is usually suspected on chest x-ray and clinical exam and confirmed with sniff test or phrenic nerve stimulation/diaphragm electromyography. In most unilateral cases no treatment is needed, especially in the absence of underlying lung disease. In more severe cases modalities such as diaphragmatic pacing or plication of the diaphragm can be used. In bilateral diaphragm paralysis or in patients with ventilatory failure continuous positive airway pressure or mechanical ventilation and tracheostomy are generally needed. Prognosis is good in unilateral paralysis, especially in the absence of underlying neurological or pulmonary process. Prognosis is usually poor in patients with advanced lung disease, bilateral paralysis, and chronic demyelinating conditions.

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“…破傷風に合併した横隔膜麻痺に関する既存の報告は，我々の検索しえた範囲ではPandaらによる報告のみである 7)が，破傷風症例127例中3例（2.4%）での横隔膜麻痺が報告されている。このうち本症例と同じく両側麻痺を認めた1例では人工呼吸管理が遷延したが，片側性の他2例を含めて全例が自然経過で改善した。1例でのみ施行されたPNCSでは潜時延長・CMAP低下を認め，横隔神経障害が原因と考察されている。本症例の横隔膜麻痺の原因については，PNCSの結果からは横隔神経障害とは診断できなかった。また，破傷風における末梢神経伝導検査では，運動・感覚神経伝導速度低下などの多発末梢神経障害の所見が，亜急性期を中心にしばしば見られ自然経過で改善することも報告されている 8), 9)。これには重症疾患ポリニューロパチーや非ヒト由来抗毒素血清使用に関連した神経炎が影響していることも考えられるが，破傷風自体により末梢神経障害が生じる可能性が考えられている。本症例でも四肢の神経伝導検査において多発末梢神経障害を示唆する所見を認めた。病前や状態改善後の評価はできておらず，破傷風発症前から存在していた可能性は否定できないが，糖尿病など頻度の高い多発末梢神経障害の原因は認めなかった。…”

Section: 考　　察unclassified

破傷風回復期に両側横隔膜麻痺を呈した1例(Diaphragmatic paralysis during recovery from tetanus: a case report)

佳代子,

靖卓,

雄史

et al. 2023

Nihon Kyukyu Igakukai Zasshi: Japanese Journal of Japanese Asso

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Respiratory failure is a common complication in patients with tetanus, and generally caused by respiratory muscle or pharyngolaryngeal spasms. Here we describe a rare case of hypercapnic respiratory failure caused by bilateral diaphragmatic paralysis in a patient with tetanus. A woman in her 80s was admitted to our ICU with tetanus. On admission, she had developed respiratory failure because of pharyngolaryngeal spasm and aspiration, and invasive ventilation was performed immediately. Because of mild general muscle spasm and the absence of autonomic dysfunction, she was ventilated with preserved spontaneous breathing, light sedation and early mobilization. Ten days later, she was extubated with improved rigidity. However, she immediately suffered hypercapnia and was reintubated. Despite tracheostomy on day 13, it was difficult to wean her from mechanical ventilation. Chest radiography showed bilateral diaphragm elevation. Diaphragm sonography showed reduced motion of the bilateral diaphragm, indicating bilateral diaphragmatic paralysis. Phrenic nerve conduction studies revealed reduced compound muscle action potential amplitudes with unremarkable prolonged latencies. Her diaphragmatic paralysis improved over time, and she was weaned from mechanical ventilation on day 23. Diaphragmatic paralysis should be considered as a cause of hypercapnic respiratory failure during recovery from tetanus.

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Phrenic Nerve Palsy in Severe Tetanus

Cited by 6 publications

References 11 publications

Maternal and neonatal tetanus

Maternal and neonatal tetanus

Diaphragm Paralysis

破傷風回復期に両側横隔膜麻痺を呈した1例(Diaphragmatic paralysis during recovery from tetanus: a case report)

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