Abstract
The incidence of cephalic tetanus, characterized by cranial nerve paralysis and symptoms localized to the head, is low at 1-3％, and it is uncommon for cardiopulmonary resuscitation and mechanical ventilation to be performed during the early stages of tetanic convulsive seizures. Our patient, a 79-year-old woman, was unaware of any injury while gathering edible wild plants 9 days prior to her examination. She presented to our department after experiencing progressive trismus, dysarthria, and dysphagia, with observed facial nerve paralysis. Following consultations with the general medicine and infectious diseases departments, she received a diagnosis of cephalic tetanus and underwent treatment in the intensive care unit （ICU）. On day 3 of hospitalization, during the early stages of convulsive seizures, she had difficulty expectorating sputum and went into cardiac arrest. Cardiopulmonary resuscitation and mechanical ventilation were initiated, and she recovered smoothly. She was discharged on day 27 of hospitalization. Thus, if a patient exhibits facial nerve paralysis along with symptoms such as trismus, dysarthria, and dysphagia, it is important to respond rapidly, considering the possibility of cephalic tetanus. Since cardiorespiratory arrest can occur even before generalized seizures begin, these cases may require ICU management from the early stages.
