Rinsho Shinkeigaku (Clinical Neurology)

Brief Clinical Note

A case of local tetanus presenting spastic paraplegia mimicking myelitis

Mai Tsuchiya, M.D.1), Fumikazu Kobayashi, M.D.1), Nobuo Yamashiro, M.D.1), Takamura Nagasaka, M.D.1), Kazumasa Shindo, M.D.1) and Yoshihisa Takiyama, M.D.1)

1)Department of Neurology, Faculty of Medicine, University of Yamanashi

A 35-year-old male was admitted to our hospital because of suspected myelitis. T2-weighted spinal MRI revealed a high intensity area at Th7-9. On admission, he showed mild weakness of the lower extremities and hyperreflexia of all extremities. Therefore, he was diagnosed with having spastic paraplegia. He presented no trismus or opisthotonos. There was pleocytosis in the cerebral spinal fluid. Dysuria, constipation and spasticity of the bilateral legs worsened, even though we administered methylprednisolone pulse therapy. Nonetheless, the symptoms had progressed on the 11th hospital day, opisthotonus and optic hyperesthesia were presented. On the 13th hospital day, we suspected local tetanus and administered tetanus toxoid. After one month, his symptoms had gradually improved. In the case of spastic paraplegia showing a subacute progression course and a faint abnormality on spinal MRI, the possibility of local tetanus should be considered.
Full Text of this Article in Japanese PDF (1225K)

(CLINICA NEUROL, 58: 688|691, 2018)
key words: local tetanus, spastic paraplegia, myelitis, spinal MRI hyperintensities

(Received: 22-Jun-18)