Tetanus differential diagnosis: Difference between revisions

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Revision as of 15:37, 12 June 2017

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Michael Maddaleni, B.S.; Associate Editor(s)-in-Chief: Usama Talib, BSc, MD [2]

Overview

Tetanus must be differentiated from strychnine poisoning, dental infections, drug reactions, hypocalcemia, meningitis, stroke and stiff man syndrome.^[1]

Differentiating Tetanus from other Diseases

Some of the other diseases that need to be considered when trying to diagnose tetanus include:^[2]^[3]^[4]

Differential for Unilateral Involuntary Face Movements

The differential diagnosis for abnormal one sided movements of the face includes:^[5]^[6]^[7]^[8]^[9]^[10]^[11]

Tetanus associated trismus
Temporomandibular joint (TMJ) dysfunction
Tetany
Unilateral jaw dystonia
Exclusive facial myokymia
Exclusive hemifacial spasm
Multiple sclerosis (MS) associated tonic spasms
Focal motor epilepsy
Hemimasticatory spasm in the presence or absence hemiatrophy of the face

**Differential Diagnosis of Tetanus**
Disease	Diagnosis			Features	Treatment
Disease	Symptoms	Signs	Laboratory Findings	Features	Treatment
Tetanus	Tonic contraction of muscles between the spasmodic episodes Trismus or lockjaw Neck stiffness Swallowing difficulty Stiffening of the calf and pectoral muscle groups	Opisthotonos Leg extension with arm flexion Risus sardonicus respiratory distress	Not significant		Diazepam Magnesium Human TIG
Neuroleptic Malignant Syndrome	History of intake of offending drugs e.g neuroleptics like: Fluphenazine Haloperidol Risperidone Autonomic instability Rigidity Disorientation Fever	Dysphagia Pallor Dyspnea Shuffling gait Agitation	Myoglobinemia Elevated LDH Elevated creatine kinase Hyperkalemia Elevated AST and ALT Hyperphosphatemia Elevated alkaline phosphatase Hyperuricemia
Meningitis^[12]^[13]	Fever Irritability Lack of appetite Lethargy Disoriented High grade fever Severe headache Stiff neck Sensitivity to bright light Nausea Vomiting	Headache Photophobia Phonophopia Pharyngitis in case of enterovirus infeciton Orchitis (In mumps) Vesicular or macular skin rash Petichiae Nuchal rigidity Signs of meningeal irritation: Kernig's sign Brudzinski's sign Altered mental status Hypotonia	CSF/plasma glucose ratio (>0.6) Lactate (mmols/l) (<2.1) Lymphocytes>granulocytes
Stiff man syndrome
Drug induced	Eye deviation Head and neck jerky movements No tonic contraction of the muscles between the spasms
Strychnine poisoning	Proper tetanus immunizations History of intentional or accidental intake			Labs: Blood assay Urine assay Tissue assay
Hypocalcaemia
Dental abscess
Parkinson's disease

References

↑ Anisha Doshi, Clare Warrell, Dima Dahdaleh & Dimitri Kullmann (2014). "Just a graze? Cephalic tetanus presenting as a stroke mimic". Practical neurology. 14 (1): 39–41. doi:10.1136/practneurol-2013-000541. PMID 24052566. Unknown parameter |month= ignored (help)
↑ E. Andreadou, E. Kattoulas, C. Sfagos & D. Vassilopoulos (2007). "Stiff person syndrome: avoiding misdiagnosis". Neurological sciences : official journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology. 28 (1): 35–37. doi:10.1007/s10072-007-0745-9. PMID 17385093. Unknown parameter |month= ignored (help)
↑ Lisa Mitchell, William Adams & Francois Aspesberro (2017). "Case 6: Episodic Stiffness in a 30-month-old Girl". Pediatrics in review. 38 (1): 52–53. doi:10.1542/pir.2014-0142. PMID 28044038. Unknown parameter |month= ignored (help)
↑ P. D. Thompson, J. A. Obeso, G. Delgado, J. Gallego & C. D. Marsden (1986). "Focal dystonia of the jaw and the differential diagnosis of unilateral jaw and masticatory spasm". Journal of neurology, neurosurgery, and psychiatry. 49 (6): 651–656. PMID 3734821. Unknown parameter |month= ignored (help)
↑ P. D. Thompson, J. A. Obeso, G. Delgado, J. Gallego & C. D. Marsden (1986). "Focal dystonia of the jaw and the differential diagnosis of unilateral jaw and masticatory spasm". Journal of neurology, neurosurgery, and psychiatry. 49 (6): 651–656. PMID 3734821. Unknown parameter |month= ignored (help)
↑ J. R. Berger, W. A. Sheremata & E. Melamed (1984). "Paroxysmal dystonia as the initial manifestation of multiple sclerosis". Archives of neurology. 41 (7): 747–750. PMID 6743065. Unknown parameter |month= ignored (help)
↑ W. B. Matthews (1975). "Paroxysmal symptoms in multiple sclerosis". Journal of neurology, neurosurgery, and psychiatry. 38 (6): 617–623. PMID 1151430. Unknown parameter |month= ignored (help)
↑ P. D. Thompson & W. M. Carroll (1983). "Hemimasticatory spasm--a peripheral paroxysmal cranial neuropathy?". Journal of neurology, neurosurgery, and psychiatry. 46 (3): 274–276. PMID 6842234. Unknown parameter |month= ignored (help)
↑ P. D. Thompson & W. M. Carroll (1983). "Hemimasticatory and hemifacial spasm: a common pathophysiology?". Clinical and experimental neurology. 19: 110–119. PMID 6568919.
↑ L. R. Jenkyn, D. B. Walsh, C. M. Culver & A. G. Reeves (1977). "Clinical signs in diffuse cerebral dysfunction". Journal of neurology, neurosurgery, and psychiatry. 40 (10): 956–966. PMID 591973. Unknown parameter |month= ignored (help)
↑ J. D. Rugh & W. K. Solberg (1976). "Psychological implications in temporomandibular pain and dysfunction". Oral sciences reviews. 7: 3–30. PMID 775369.
↑ Chow E, Troy SB (2014). "The differential diagnosis of hypoglycorrhachia in adult patients". Am J Med Sci. 348 (3): 186–90. doi:10.1097/MAJ.0000000000000217. PMC 4065645. PMID 24326618.
↑ Leen WG, Willemsen MA, Wevers RA, Verbeek MM (2012). "Cerebrospinal fluid glucose and lactate: age-specific reference values and implications for clinical practice". PLoS One. 7 (8): e42745. doi:10.1371/journal.pone.0042745. PMC 3412827. PMID 22880096.

Template:WH Template:WS

[1] Anisha Doshi, Clare Warrell, Dima Dahdaleh & Dimitri Kullmann (2014). "Just a graze? Cephalic tetanus presenting as a stroke mimic". Practical neurology. 14 (1): 39–41. doi:10.1136/practneurol-2013-000541. PMID 24052566. Unknown parameter |month= ignored (help)

[2] E. Andreadou, E. Kattoulas, C. Sfagos & D. Vassilopoulos (2007). "Stiff person syndrome: avoiding misdiagnosis". Neurological sciences : official journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology. 28 (1): 35–37. doi:10.1007/s10072-007-0745-9. PMID 17385093. Unknown parameter |month= ignored (help)

[3] Lisa Mitchell, William Adams & Francois Aspesberro (2017). "Case 6: Episodic Stiffness in a 30-month-old Girl". Pediatrics in review. 38 (1): 52–53. doi:10.1542/pir.2014-0142. PMID 28044038. Unknown parameter |month= ignored (help)

[4] P. D. Thompson, J. A. Obeso, G. Delgado, J. Gallego & C. D. Marsden (1986). "Focal dystonia of the jaw and the differential diagnosis of unilateral jaw and masticatory spasm". Journal of neurology, neurosurgery, and psychiatry. 49 (6): 651–656. PMID 3734821. Unknown parameter |month= ignored (help)

[5] P. D. Thompson, J. A. Obeso, G. Delgado, J. Gallego & C. D. Marsden (1986). "Focal dystonia of the jaw and the differential diagnosis of unilateral jaw and masticatory spasm". Journal of neurology, neurosurgery, and psychiatry. 49 (6): 651–656. PMID 3734821. Unknown parameter |month= ignored (help)

[6] J. R. Berger, W. A. Sheremata & E. Melamed (1984). "Paroxysmal dystonia as the initial manifestation of multiple sclerosis". Archives of neurology. 41 (7): 747–750. PMID 6743065. Unknown parameter |month= ignored (help)

[7] W. B. Matthews (1975). "Paroxysmal symptoms in multiple sclerosis". Journal of neurology, neurosurgery, and psychiatry. 38 (6): 617–623. PMID 1151430. Unknown parameter |month= ignored (help)

[8] P. D. Thompson & W. M. Carroll (1983). "Hemimasticatory spasm--a peripheral paroxysmal cranial neuropathy?". Journal of neurology, neurosurgery, and psychiatry. 46 (3): 274–276. PMID 6842234. Unknown parameter |month= ignored (help)

[9] P. D. Thompson & W. M. Carroll (1983). "Hemimasticatory and hemifacial spasm: a common pathophysiology?". Clinical and experimental neurology. 19: 110–119. PMID 6568919.

[10] L. R. Jenkyn, D. B. Walsh, C. M. Culver & A. G. Reeves (1977). "Clinical signs in diffuse cerebral dysfunction". Journal of neurology, neurosurgery, and psychiatry. 40 (10): 956–966. PMID 591973. Unknown parameter |month= ignored (help)

[11] J. D. Rugh & W. K. Solberg (1976). "Psychological implications in temporomandibular pain and dysfunction". Oral sciences reviews. 7: 3–30. PMID 775369.

[pmid24326618-12] Chow E, Troy SB (2014). "The differential diagnosis of hypoglycorrhachia in adult patients". Am J Med Sci. 348 (3): 186–90. doi:10.1097/MAJ.0000000000000217. PMC 4065645. PMID 24326618.

[pmid22880096-13] Leen WG, Willemsen MA, Wevers RA, Verbeek MM (2012). "Cerebrospinal fluid glucose and lactate: age-specific reference values and implications for clinical practice". PLoS One. 7 (8): e42745. doi:10.1371/journal.pone.0042745. PMC 3412827. PMID 22880096.

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@@ Line 157: / Line 157: @@
 | style="background: #DCDCDC; padding: 5px;" |
 *Tonic contraction of muscles between the spasmodic episodes
-| style="background: #F5F5F5; padding: 5px; text-align: center;" |
+*[[Trismus]] or lockjaw
+* [[Neck stiffness]]
+* [[Swallowing difficulty]]
+* Stiffening of the calf and pectoral muscle groups
+| style="background: #F5F5F5; padding: 5px; text-align: center;" |
+** [[Opisthotonos]]
+** Leg [[extension]] with arm [[flexion]]
+** [[Risus sardonicus]]
+** [[respiratory distress]]
 | style="background: #DCDCDC; padding: 5px;" |
+* Not significant
 | style="background: #F5F5F5; padding: 5px; text-align: center;" |
 | style="background: #DCDCDC; padding: 5px;" |
+* [[Diazepam]]
+* [[Magnesium]]
+* Human TIG
 |-
 | style="background: #F5F5F5; padding: 5px; text-align: center;" | [[Neuroleptic malignant syndrome|Neuroleptic Malignant Syndrome]]
 | style="background: #DCDCDC; padding: 5px;" |
-*History of intake of offending drug
+*History of intake of offending drugs e.g [[neuroleptics]] like:
-*Autonomic instability
+**[[Fluphenazine]]
-*Rigidity
+**[[Haloperidol]]
-*Disorientation
+**[[Risperidone]]
-*Fever
+*[[Autonomic instability]]
-| style="background: #F5F5F5; padding: 5px; text-align: center;" |
+*[[Stiffness|Rigidity]]
+*[[Disorientation]]
+*[[Fever]]
+| style="background: #F5F5F5; padding: 5px; text-align: center;" |
+* [[Dysphagia]]
+* [[Pallor]]
+* [[Dyspnea]]
+* [[Shuffling gait]]
+* [[Agitation]]
 | style="background: #DCDCDC; padding: 5px;" |
+** [[Myoglobinemia]]
+** Elevated [[LDH]]
+** Elevated [[creatine kinase]]
+** [[Hyperkalemia]]
+** Elevated [[AST]] and [[ALT]]
+** [[Hyperphosphatemia]]
+** Elevated [[alkaline phosphatase]]
+** [[Hyperuricemia]]
 | style="background: #F5F5F5; padding: 5px; text-align: center;" |
 | style="background: #DCDCDC; padding: 5px;" |