Back arching, opisthotonus: what is this, symptoms, diagnostics, treatment, prevention

Synonyms: Back arching; Opisthotonus; Decerebrate rigidity opisthotonus

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

What is opisthotonus

Opisthotonus is a state, in which the human body arches unnaturally. The person is usually immobile and arches the back, the head is thrown back. If a person with opisthotonus lies on his back, then the surfaces touch only the back of the head and heels.

Opisthotonus is much more common in infants and children, than in adults. This is due to the fact, that in infants and children the nervous system is not yet sufficiently developed.

Causes of opisthotonus

Opisthotonus can occur in infants with meningitis. It's an infection of the meninges, covering the brain and spinal cord. Opisthotonus can also occur as a sign of decreased brain function or damage to the nervous system..

Other causes of opisthotonus may include:

• Cerebromedullary malformation syndrome, brain structure problems
• Encephaloma
• Cerebral Palsy
• Gaucher Bolezny, causing the accumulation of adipose tissue in certain organs
• growth hormone deficiency (sometimes)
• Forms of chemical poisoning, called glutaric aciduria and organic acidemia.
• Krabbe disease, which destroys the surface of the nerves in the central nervous system.
• Болезнь “кленового сиропа”, disorder, in which the body cannot break down certain parts
  proteins.
• Convulsions
• Severe electrolyte imbalance
• Traumatic brain injury
• Chained Man Syndrome (state, which makes a person rigid and causes spasms)
• Hemorrhage in the brain
• Stolbnyak

Some neuroleptics may cause side effects, called acute dystonic reaction. Opisthotonus may be part of this reaction.

Rarely in infants, born to women, drinking large amounts of alcohol during pregnancy, may experience opisthotonus due to alcohol withdrawal.

The first steps about the appearance of opisthotonus

Human, who has opisthotonus, should be sent to the hospital as soon as possible.

When to See a Doctor for Opisthotonus

Call an ambulance immediately, if symptoms of opisthotonus occur. Usually, opisthotonus is a symptom of other diseases, which are very dangerous.

What will the doctor do when diagnosing opisthotonus

The hospital will assess the health of the patient, and emergency action will be taken if necessary..

A health worker will perform a physical exam and ask about symptoms, to find the cause of opisthotonus.

Questions may include:

• When symptoms appeared?
• Is body position always the same??
• What other symptoms appeared before or after the onset of opisthotonus (eg, fever, neck stiffness or headache)?
• Is there a recent medical history?

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

Tests may include:

• Blood tests and urine
• Microbiological examination of cerebrospinal fluid (TsSJ) and cell count
• Head CT
• Electrolyte analysis
• Lumbar puncture (spinnomozgovaya puncture)
• MRI of the brain

Treatment will depend on the cause of opisthotonus.. For Example, if the cause is meningitis, They can be assigned to medication.

Sources

1. Berger JR, Price R. Stupor and coma. In: Jankovic J, Mazziotta JC, Pomeroy SL, Newman NJ, eds. Bradley and Daroff’s Neurology in Clinical Practice. 8th ed. Philadelphia, PA: Elsevier; 2022:chap 5.
2. Birch TB, Bleck TP. Tetanus (Clostridium tetani). In: Bennett JE, Dolin R, Blaser MJ, eds. Mandell, Douglas, and Bennett’s Principles and Practice of Infectious Diseases. 9th ed. Philadelphia, PA: Elsevier; 2020:chap 244.
3. Kliegman RM, St. Geme JW, Blum NJ, Shah SS, Tasker RC, Wilson KM. Defects in metabolism of amino acids. In: Kliegman RM, St. Geme JW, Blum NJ, Shah SS, Tasker RC, Wilson KM, eds. Nelson Textbook of Pediatrics. 21st ed. Philadelphia, PA: Elsevier; 2020:chap 103.