Abstract
We report four patients with tetanus who were treated successfully. The initial symptoms of our patients varied. Dysphagia preceded trismus in three of the four patients, and two patients were initially misdiagnosed as having a new stroke. Two severely affected patients showed respiratory distress and autonomic dysfunction, and required mechanical ventilation. One elderly patient exhibited a transient myoclonic state. Although rare in developed countries, tetanus should be considered when encountering a patient with dysphagia and dysarthria, and later showing difficulty in opening the mouth. Intensive care is necessary for patients with generalized tetanus. Elderly patients should particularly be treated carefully because the prognosis remains poor.
