Shahani M, Dastur F D, Dastoor D H, Mondkar V P, Bharucha E P, Nair K G, Shah J C
J Neurol Sci. 1979 Oct;43(2):173-82. doi: 10.1016/0022-510x(79)90113-8.
Thirty-four cases of severe tetanus were studied. On clinical examination weakness and sensory loss compatible with peripheral neuropathy was found in 27. The pattern was usually asymmetrical, the commonest nerves affected being ulnar, median and lateral popliteal, although occasionally circumflex, musculocutaneous, femoral and facial nerves were also involved. Electrophysiological studies showed spontaneous activity resembling denervation potentials, diphasic and positive sharp waves. In some muscles there was also activity resembling spontaneous firing of motor units. Motor and sensory conduction velocities in the affected nerves were moderately reduced and the amplitude of sensory potentials was also reduced. No conduction was found in 11 nerves in 8 patients on initial studies, but 4 out of 7 nerves that could be studied showed rapid recovery. Although most of the nerves in the rest of the patients showed clinical recovery, conduction velocities showed improvement most often when examined about 10 weeks after the onset of trismus. The clinical and electrophysiological evidence suggests the involvement of peripheral nerves in severe tetanus. Serum neuritis, hypersensitivity reaction to tetanus toxoid or drug-induced neuropathy have been ruled out.
对34例重症破伤风患者进行了研究。临床检查发现，27例存在与周围神经病变相符的肌无力和感觉丧失。其表现通常不对称，最常受累的神经为尺神经、正中神经和腘外侧神经，不过偶尔也会累及旋肱后神经、肌皮神经、股神经和面神经。电生理研究显示存在类似失神经电位的自发活动、双相波和正锐波。在一些肌肉中还存在类似运动单位自发放电的活动。受累神经的运动和感觉传导速度中度降低，感觉电位幅度也降低。初始研究时，8例患者的11条神经未检测到传导，但7条可检测的神经中有4条显示快速恢复。虽然其余患者的大多数神经显示临床恢复，但在牙关紧闭发作约10周后检查时，传导速度最常出现改善。临床和电生理证据提示重症破伤风累及周围神经。已排除血清神经炎、对破伤风类毒素的过敏反应或药物性神经病变。
