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.
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.
Opisthotonos may occur in infants with meningitis. It may also occur as a sign of reduced brain function or injury to the nervous system.
Other causes may include:
- A problem with the structure of the brain called Arnold-Chiari syndrome
- Brain tumor
- 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
- Severe electrolyte imbalance
- Severe head injury
- Stiff-person syndrome (a condition that makes a person rigid and have spasms)
- Bleeding in the brain
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.
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.
Your health care provider will take a medical history and perform a physical examination to look for the cause of opisthotonos
Medical history questions may include:
- When did this behavior start?
- Is it always the same type of posturing?
- What other symptoms came before or with the abnormal posturing (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:
- Blood and urine tests
- Cerebrospinal fluid (CSF) culture and cell counts
- CT scan of the head
- Electrolyte analysis
- Lumbar puncture (spinal tap)
- MRI of the brain
Chiriboga CA. HIV, fetal alcohol and drug effects, and the battered child. In: Rowland LP, Pedley TA, eds. Merritt's Neurology. 12th ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2009.
Layzer RB, Rowland LP. Muscle cramps and stiffness. Merritt's Neurology. 12th ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2009:chap 145.
Patterson MC, Johnson WG. Lysosomal and other storage diseases. In: Rowland LP, Pedley TA, eds. Merritt's Neurology. 12th ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2009.
Scher MS, Diagnosis and treatment of neonatal seizures. In: Perlman JM, ed. Neurology: Neonatal Questions and Controversies. 2nd ed. Philadelphia, PA: Elsevier Saunders; 2012:chap 8.
Thwaites LC, Yen LM. Tetanus, In: Farrar J, Hotez PJ, Junghanss T, Kang G, Lalloo D, White NJ, eds. Manson's Tropical Diseases. 23rd ed. Philadelphia, PA: Elsevier Saunders; 2014:chap 32.
Review Date: 6/1/2015
Reviewed By: Daniel Kantor, MD, Kantor Neurology, Coconut Creek, FL and Immediate Past President of the Florida Society of Neurology (FSN). Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.