Autonomic complications in a case of severe tetanus

Kerr, John H.; Travis, Kenneth W.; O’Rourke, Robert A.; Sims, J.K.; Uhl, Richard R.

doi:10.1016/0002-9343(74)90455-0

Cited by 11 publications

(6 citation statements)

References 14 publications

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“…The hypotension was not due to sustained sympathetic nervous overactivity, since small doses of noradrenaline produced a rise in blood pressure and heart rate in these patients, but may represent another effect of tetanus on autonomic nervous activity including impairment of baroreceptor reflexes [13]. A further patient who developed a phase of hypotension when sympathetic activity appeared minimal was described by Kerr et al [30]. The development of hypotension responding to catecholamines was also reported by Drost [16].…”

Section: Cardiovascular Disturbancessupporting

confidence: 53%

“…Tachycardia above 140/min was exhibited by 65% of the patients, who finally died [32]. These cardiovascular symptoms are reported to initiate 2-10 days after the onset of trismus [7,12,16,23,24,28,30]. The duration of this symptoms varied from a few days to two weeks [28].…”

Section: Cardiovascular Disturbancesmentioning

confidence: 99%

“…A number of authors have commented on this cardiovascular lability [10, 11, 12, 15, 16, 23, 24, 26-30, 32, 42]. The tachycardia can be accompanied by arryhthmias [29,30,38]. Exaggerated cardiovascular responses occur to common stimuli like endotracheal suction and are superimposed on spontaneous changes [12,38].…”

Section: Cardiovascular Disturbancesmentioning

confidence: 99%

“…Additionally, depression or elevation of S-T segments and notching, elevation or depression of T waves have been described [3,23,28,30,35,40]. Such electrocardiographic changes can also occur in patients with a phaeochromocytoma [9], or in patients with subarachnoid haemorrhage [21], a condition known to be frequently accompanied by massive stimulation of the sympathetic nervous system.…”

Section: Electrocardiogrammentioning

confidence: 99%

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The involvement of the sympathetic nervous system in tetanus

1979

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Besides the characteristic disturbances of the motor nervous system symptoms indicating an overactivity of the sympathetic nervous system can complicate the course of severe cases of tetanus. These symptoms include fluctuating tachycardia and hypertension, electrocardiographic changes, sweating, constipation with development of paralytic ileus and metabolic disorders. These symptoms are comparable to these developing in patients with phaeochromocytoma. Elevated catecholamine levels in plasma and urine have been found in several patients with tetanus who developed these symptoms. The prolonged over-activity of the sympathetic nervous system is thought to contribute to the still considerably high mortality rate. Myocardial lesions observed at necropsy are comparable to those found in patients dying of phaeochromocytoma. These lesions are suggested to be associated with sudden death from arrhythmias or cardiac failure in patients with tetanus. For the protection of the organism against the overactivity of the sympathetic nervous system a treatment using the combination of beta-adrenergic receptor blocking agents and adrenergic neuron blocking agents has been introduced. A reduction of the mortality rate was achievable by this treatment. Experimental evidence is accumulating that the tetanus toxin affects not only the motor, but also the sympathetic and sensory neurons.

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Section: Cardiovascular Disturbancessupporting

confidence: 53%

Section: Cardiovascular Disturbancesmentioning

confidence: 99%

Section: Cardiovascular Disturbancesmentioning

confidence: 99%

Section: Electrocardiogrammentioning

confidence: 99%

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The involvement of the sympathetic nervous system in tetanus

1979

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“…The involvement of the sympathetic nervous system in severe cases of tetanus has been discussed in several publications since 1968 [3,4,9,12,14,15]. Patients with severe tetanus can develop a characteristic syndrome which is highly suggestive of a hyperactivity of the sympathetic nervous system including hypertension, tachycardia, irregularities of cardiac rhythm, peripheral vascular constriction, profuse sweating, pyrexia.…”

Section: Abstract: Tetanus -Sympathetic Nervous System -Catecholaminmentioning

confidence: 99%

Dysfunction of the sympathetic nervous system in tetanus

1979

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In severe cases of tetanus an overactivity of the sympathetic nervous system has been postulated because of the clinical symptoms including hypertension, fluctuating blood pressure, tachycardia, tachyarrhythmia and peripheral vasoconstriction. In the present study the involvement of the sympathetic nervous system in tetanus was investigated by serial determinations of plasma adrenaline (A) and noradrenaline (NA) in 2 patients who developed severe symptoms of tetanus and the characteristic cardiovascular disturbances. Sustained high circulating levels of NA and A could be observed indicating a prolonged overactivity of the sympathetic nervous system. In one case, the elevation of the NA level in plasma persisted until the disturbances of the motor nervous system ceased. In a third case of tetanus without cardiovascular abnormalities, the plasma NA and A only increased slightly on a few occasions. The results demonstrate that an overactivity of the sympathetic nervous system can complicate the course of severe tetanus.

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Evaluation of left ventricular performance during sympathetic nervous storm in a case with severe tetanus by transesophageal M-mode echocardiography

et al. 1984

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Transesophageal M-mode echocardiography was applied for the evaluation of left ventricular performance in a case of severe tetanus with labile hypertension due to sympathetic nervous 'storm'. When systemic blood pressure was elevated, increases in pulmonary arterial pressure, cardiac output, left ventricular enddiastolic diameter, fractional shortening and mean velocity of circumferential fiber shortening were noted. No changes were found in total peripheral vascular resistance or left ventricular endsystolic diameter. Positive pressure ventilation, rendered standard transthoracic echocardiography ineffective.

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Autonomic complications in a case of severe tetanus

Cited by 11 publications

References 14 publications

The involvement of the sympathetic nervous system in tetanus

The involvement of the sympathetic nervous system in tetanus

Dysfunction of the sympathetic nervous system in tetanus

Evaluation of left ventricular performance during sympathetic nervous storm in a case with severe tetanus by transesophageal M-mode echocardiography

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