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Opisthotonos

Opisthotonos is a condition in which a person holds their body in an abnormal position. The person is usually rigid and arches their back, with their head thrown backward. If a person with opisthotonos lies on their back, only the back of their head and heels touch the surface they are on.

Considerations

Opisthotonos is much more common in infants and children than in adults. It is also more extreme in infants and children because of their less mature nervous systems.

Causes

Opisthotonos may occur in infants with meningitis. This is an infection of the meninges, the membranes that cover the brain and spinal cord. Opisthotonos may also occur as a sign of reduced brain function or injury to the nervous system.

Other causes may include:

  • Arnold-Chiari syndrome, a problem with the structure of the brain
  • Brain tumor
  • Cerebral palsy
  • Gaucher disease, which causes a buildup of fatty tissue in certain organs
  • Growth hormone deficiency (occasionally)
  • Forms of chemical poisoning called glutaric aciduria and organic acidemias
  • Krabbe disease, which destroys the coating of nerves in the central nervous system
  • Maple syrup urine disease, a disorder in which the body can't break down certain parts of proteins
  • Seizures
  • Severe electrolyte imbalance
  • Traumatic brain injury
  • Stiff-person syndrome (a condition that makes a person rigid and have spasms)
  • Bleeding in the brain
  • Tetanus

Some antipsychotic medicines can cause a side effect called acute dystonic reaction. Opisthotonos may be part of this reaction.

In rare cases, infants born to women who drink large amounts of alcohol during pregnancy may have opisthotonus due to alcohol withdrawal.

Home Care

A person who develops opisthotonos will need to be cared for in a hospital.

When to Contact a Medical Professional

Go to the emergency room or call your local emergency number (such as 911) if symptoms of opisthotonos occur. Typically, opisthotonos is a symptom of other conditions that are serious enough for a person to seek medical attention.

What to Expect at Your Office Visit

This condition will be evaluated in a hospital, and emergency measures may be taken.

The health care provider will perform a physical examination and ask about symptoms to look for the cause of opisthotonos

Questions may include:

  • When did the symptoms start?
  • Is the body positioning always the same?
  • What other symptoms came before or with the abnormal positioning (such as fever, stiff neck, or headache)?
  • Is there any recent history of illness?

The physical examination will include a complete checkup of the nervous system.

Tests may include:

Treatment will depend on the cause. For example, if meningitis is the cause, medicines may be given.

Alternative Names

Back arching; Abnormal posturing - opisthotonos; Decerebrate posture - opisthotonos

References

Berger JR. Stupor and coma. In: Daroff RB, Jankovic J, Mazziotta JC, Pomeroy SL, eds. Bradley's Neurology in Clinical Practice. 7th ed. Philadelphia, PA: Elsevier; 2016:chap 5.

Hamati AI. Neurological complications of systemic disease: children. In: Daroff RB, Jankovic J, Mazziotta JC, Pomeroy SL, eds. Bradley's Neurology in Clinical Practice. 7th ed. Philadelphia, PA: Elsevier; 2016:chap 59.

Hodowanec A, Bleck TP. Tetanus (Clostridium tetani). In: Bennett JE, Dolin R, Blaser MJ, eds. Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases, Updated Edition. 8th ed. Philadelphia, PA: Elsevier Saunders; 2015:chap 246.

Rezvani I, Ficicioglu CH. Defects in metabolism of amino acids. In: Kliegman RM, Stanton BF, St. Geme JW, Schor NF, eds. Nelson Textbook of Pediatrics. 20th ed. Philadelphia, PA: Elsevier; 2016:chap 85.

Review Date 5/15/2017

Updated by: Amit M. Shelat, DO, FACP, Attending Neurologist and Assistant Professor of Clinical Neurology, SUNY Stony Brook, School of Medicine, Stony Brook, NY. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.