Vacuolation and chromatolysis of lower motoneurons in tetanus

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In recent years, the pathophysiological action of tetanus toxin has been extensively studied by many investigators.1, 2 The role of the toxin in decreasing inhibitory input to alpha motoneurons is well known. Morphological alterations in neurons in both clinical and experimental tetanus have not been consistently described. Indeed, several authors simply state that no changes are found. There are, however, reports of nuclear capping, and either chromophobia or chromophilia3 as well as central or perinuclear chromatolysis in motoneurons4, 5 in tetanus. The finding of striking concurrence of central chromatolysis and vacuolation confined to motoneurons in a case of human tetanus prompts this report and a review of the literature.

Case report

A 58-year-old black man was admitted because of inability to swallow. The night before admission, he choked while trying to drink water; he also noted pain and stiffness in the neck and back. He was diabetic and took 40 units of insulin each morning. He had had an ulcer on his left heel for the preceding 10 months, but there was no history of recent wounds. He had not had a tetanus immunization for “many years.” Chronic ulcers on the right leg had necessitated an above-the-knee amputation 1½ years before. The patient also had been taking phenytoin (Dilantin) and phenobarbital for a seizure disorder, which apparently followed a stroke for which he had had a carotid bypass.

The patient initially went to the emergency room of a local hospital and was found to have risus sardonicus, opisthotonus, and dysphagia; . . .



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