Cephalic tetanus in an immunized patient. Clinical and electromyographic findings

A case of cephalic tetanus that occurred in a fully immunized patient is described. An 18-year-old man presented with bilateral facial spasms, without trismus or more generalized involvement, followed by facial weakness. The difficulties in clinical diagnosis and the contribution of electrophysiological studies to the management of such patients are highlighted. The variable level of protection that is conferred by immunization is discussed.