Cephalic Tetanus: A Rare Case Report.

INTRODUCTION: Tetanus is a preventable infectious disease with vaccination. Cephalic tetanus is the rarest form in which local tetanus can involve the cranial nerves. CASE: Herein, we report a case of cephalic tetanus in a 16-month-old girl who had never been vaccinated. The patient, who had a complaint of a wound on the cheek mucosa for 2 weeks, was seen playing with the soil in the garden 1 week ago and was found to have abundant soil removed by her mother. The patient was diagnosed as cephalic tetanus according to her complaints and clinical findings. DISCUSSION: We believe that, this is the first case reported in the literature of cephalic tetanus in such a young child wherein the disease focus of infection from a wound on the cheek mucosa. The symptom we defined as 'a child who cries when she smiles' presented in this case could only be associated with this disease. CONCLUSION: In addition to detailed anamnesis and meticulous physical examination, the clinical symptoms that we have described for the first time in a child with cephalic tetanus should also be considered for early and accurate diagnosis.

Multiple cranial nerve involvement in Bannwarth's syndrome.

Bannwarth's syndrome is a tick-transmitted neurological disease caused by spirochetes of the Borrelia burgdorferi group. Neurological manifestations of the disease occur after skin erythema and include: neuritic pain, lymphocytic pleocytosis without headache and sometimes cranial neuritis. We present the case of a man who complained of a neurological syndrome without evidence of tick bite and concurrent manifestation of the infection, for whom serological analysis only revealed the infection after testing repetitive specimens. We discuss the need to start early therapy when clinical manifestations are suggestive of the disease in endemic areas.

Orbital and cranial nerve presentations and sequelae are hallmarks of invasive fungal sinusitis caused by Mucor in contrast to Aspergillus.

BACKGROUND: Acute fulminant invasive fungal sinusitis (IFS) is a rapidly progressing, destructive process almost exclusively affecting immunocompromised patients. Outcome differences have been found in patients with Mucor and Aspergillus. We performed this study to compare the presenting symptoms and long-term morbidity with IFS caused by Mucor versus Aspergillus species. METHODS: Retrospective chart review was performed of 48 patients with 49 cases of acute fulminant IFS over a 19-year period. Presenting symptoms and long-term morbidity related to the orbits and cranial nerves were evaluated. RESULTS: Mucor was found in 22 cases and Aspergillus was found in 27 cases. Orbital (proptosis, periorbital edema, and ophthalmoplegia) and cranial nerve symptoms were seen at presentation more often in Mucor (6 [27%] and 9 [41%]) than in Aspergillus patients (3 [11%] and 7 [26%]; p=0.079). Long-term orbital and cranial nerve sequelae occurred in 16 (72%) Mucor cases and 10 (37%) Aspergillus cases (p=0.0210). The IFS-related mortality was 32% (7) in the Mucor group and 11% (3) in the Aspergillus group (p=0.089). CONCLUSION: Patients with acute fulminant IFS present with similar sinus symptoms; however, there is a trend toward a greater prevalence of orbital and neurological symptoms in patients with Mucor versus Aspergillus. Long-term orbital and neurological morbidity is more prevalent in patients with Mucor compared with Aspergillus. These data suggest that the presence of orbital and neurological symptoms at presentation warrants more aggressive surgical intervention because of the likelihood of Mucor.

Cavernous sinus anatomy as a basis for interpretation of the clinical picture and radiological investigations in a case of Entomophthorales infection.

Several cranial nerves traverse the cavernous sinus producing the typical symptom complex seen during cavernous venous sinus thrombosis in Mucorales infection. Fungi of the order Entomophthorales display different pathological and histological characteristics although belonging to the same class of fungi. A case is presented, wherein the anatomy of the cavernous sinus forms the basis in explaining the presenting symptoms of a patient with Entomophthorales infection. The anatomical explanation for the presenting neurological symptoms is confirmed by radiological investigations and further supports the diagnosis of Entomophthorales infection.

Lemierre's syndrome complicated by carotid thrombosis.

Lemierre's syndrome, also known as postanginal sepsis, is a rare condition that presents as an increasing sore throat due to acute pharyngitis or tonsillitis and progresses to sepsis, due to suppurative thrombophlebitis of the internal jugular vein. We present an atypical case of Lemierre's syndrome complicated by carotid thrombosis. The etiological factors and the diagnostic and therapeutic measures are discussed.

[Otorhinolaryngological manifestations of varicella-zoster virus]. / Manifestaciones otorrinolaringológicas del virus varicela-zoster.

Otological complications of varicella-zoster syndrome (Ramsay Hunt syndrome) include facial paralysis, tinnitus, hearing loss, vertigo, dysgeusia, and skin rash. The lower cranial nerves sometimes are affected by this neuritis. A case is reported of a woman without immune-system impairment who had cranial multineuritis with unilateral involvement of the VII, VIII, IX and X cranial nerves after infection with varicella-zoster virus without herpetic lesions.

Differential accumulation of herpes simplex virus type 1 latency-associated transcripts in sensory and autonomic ganglia.

We have analyzed the capacity of sensory and autonomic ganglia to demonstrate latency-associated transcripts (LATs) following inoculation of the anterior chamber of the mouse eye with Herpes simplex virus type 1 (HSV-1). In autonomic ganglia, the number of LAT-containing neurons decreased 50-fold or more from the acute to the latent phase, while in the trigeminal ganglion, the decrease was less than 2-fold. The decrease in autonomic ganglia could not be related to destruction of neurons expressing LATs, since these ganglia harbored substantial amounts of viral DNA. The data demonstrate that during the latent phase of the infection, accumulation of LATs varies depending on the type of infected neuron and suggest that some neurons may harbor a latent infection in the absence of LAT expression.