Opisthotonos is an abnormal posturing condition characterized by rigidity and severe arching of the back, with the head thrown backwards. This is such that if a person were laid on his or her back, only the back of the head and the heels would touch the supporting surface.

Opisthotonos may occur in Meningitis in infants, and it is a sign of irritation of the membranes surrounding the brain and spinal cord (meninges). It may occur as a posture reflective of depressed brain function or injury to the nervous system.

Opisthotonos is much more common in infants and children than in adults. It is also more exaggerated in infants and children. This is a reflection of the relative immaturity of their nervous systems.

Common Causes  

  • Meningitis  
  • Arnold-Chiari syndrome  
  • Subarachnoid hemorrhage  
  • Tetanus  
  • brain tumor  
  • Severe Head injury  
  • Glutaric aciduria and organic acidemias  
  • Gaucher disease  
  • Krabbe Disease  
  • Achondroplastic dwarfism (occasionally)

Drugs, particularly phenothiazines and other antipsychotic medications, can cause a side effect known as acute dystonic reaction. Opisthotonos may be part of this reaction.

Home Care 
Hospital care is required for a person who develops opisthotonos.

Call your health care provider if 
Go to the emergency room, or see your physician immediately if this symptom occurs! Typically, however, opisthotonos is a symptom that follows late in the course of other conditions which are serious enough that medical attention will already have been sought.

What to expect at your health care provider’s office  
This condition will be evaluated in a hospital setting. Emergency measures will be taken as appropriate.

The medical history will be obtained, and a physical examination will be performed.

Medical history questions documenting opisthotonos in detail may include:

  • When did this behavior start?  
  • Is it always the same type of posturing?  
  • What other symptoms preceded or accompanied the abnormal posturing (particularly fever, stiff neck, headache, but also any others)?  
  • Is there any significant medical history (such as a recent illness)?

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

The cause of the opisthotonos will be suggested by the history and physical examination. Diagnostic tests may include:

  • lumbar puncture and analysis of the cerebrospinal fluid (CSF culture, CSF cell counts, and similar studies), electrolyte analysis  
  • CT scan of the head  
  • MRI of the head  
  • Blood and urine tests

Johns Hopkins patient information

Last revised: December 4, 2012
by Janet G. Derge, M.D.

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All ArmMed Media material is provided for information only and is neither advice nor a substitute for proper medical care. Consult a qualified healthcare professional who understands your particular history for individual concerns.