Brachial plexus paralysis following administration of tetanus antitoxin

Abstract

Brachial plexus neuritis (paralysis), a peculiar anatomical localization of peripheral neuritis, occurs in rare instances after the injection of tetanus antitoxin [II]. About 127 cases of horse serum neuritis have been recorded in the world literature. The severe symptoms, confined to the shoulder, neck and arm, with involvement principally of the deltoid and shoulder cuff muscles, make an early diagnosis possible. The affected muscles (deltoid, supraspinatous and infraspinatous) are involved as a result of impairment of their nerve supply (axillary and suprascapular nerves). The cause of this neurological complication, as well as of the usually concomitant serum sickness, is unknown. In our opinion the theory of perineural compressive edema is logical, and tetanus antitoxin apparently shows a tissue selectivity for certain nerves or nerve groups. Early diagnosis and early treatment will prevent residual muscle atrophy and weakness in most cases. Treatment recommended is early administration of cortisone, complete rest of the involved muscles during the acute stage, analgesics and narcotics, local heat therapy, parenteral vitamin B, and early physiotherapy. Universal active immunization with tetanus toxoid is strongly advised as a method that will reduce the incidence of this complication. In the meantime, discretion should be used in the administration of tetanus antitoxin. The prognosis for complete recovery is good, but approximately 20 per cent of the patients have some residual muscle atrophy and weakness.