Comprehensive review including cephalic tetanus management
Source for antitoxin dosing, antibiotic selection, and ICU care protocols
Sudarshan R, Sayo AR, Renner DR, et al. Tetanus: Recognition and Management. Lancet Infect Dis. 2025. PMID 40543524
Differential diagnosis framework for cephalic tetanus
Epidemiology and outcome data including 61% disability-free survival
Yen LM, Thwaites CL. Tetanus. Lancet. 2019. PMID 30935736
Spatula test sensitivity and specificity data
Scoring system and severity classification
Landmark trials
Thwaites CL, Yen LM, Loan HT, et al. Magnesium sulphate for treatment of severe tetanus: a randomised controlled trial. Lancet. 2006. PMID 17055945
Primary RCT evidence for magnesium in tetanus
Reduced sedation requirements; no significant mortality benefit
Pham OKN, Tran BN, Duong MC, et al. Cardiovascular events in tetanus cohort study. Open Forum Infect Dis. 2023. PMID 37795506
Takotsubo cardiomyopathy as leading cardiovascular complication
Fabris F, Varani S, Tonellato M, et al. Facial neuromuscular junctions and brainstem nuclei as targets in cephalic tetanus. JCI Insight. 2023. PMID 37159261
Mechanistic basis for cephalic variant pathophysiology
Vaccination guidelines
Liang JL, Tiwari T, Moro P, et al. Prevention of Pertussis, Tetanus, and Diphtheria. MMWR Recomm Rep. 2018. PMC5919600
ACIP recommendations for tetanus vaccination schedules
Wound prophylaxis decision algorithms
Hughes MM, Amin AB, Rubis AB. Tetanus Surveillance United States 2009 to 2023. MMWR Surveill Summ. 2026. PMID 41980046
US epidemiology; 43.9% of cases unvaccinated
Risk factor distribution and trends
Additional references
Nascimento FA, Hammoud N, Augusto FD. Cephalic Tetanus: Not Every Facial Weakness Is Bell Palsy. Neurology. 2019. PMID 31740518
Diagnostic distinction from Bell palsy
Case-based teaching on cephalic tetanus recognition
Thwaites CL, Beeching NJ, Newton CR. Maternal and Neonatal Tetanus. Lancet. 2015. PMID 25149223
Pregnancy and neonatal considerations
Maternal immunization benefits
Zhou S, Malani P. What Is Tetanus? JAMA. 2026. DOI 10.1001/jama.2026.2744
Patient-facing clinical overview
Low-stimulation environment and supportive care principles
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