Opisthotonos


Opisthotonos

Description, Causes and Risk Factors:

A tetanic spasm in which the spine and extremities are bent with convexity forward, the body resting on the head and the heels.

Opisthotonos or opisthotonus is seen clinically as an extreme hyperextension spasticity pattern where the patient assumes a total "bridging" or "arching" position. The individuals with the condition may primarily arch or curl up in bed so that they are bearing weight on their heels (that are contacting their buttocks) and the back of their head is resting on the spine. Some may even develop decubitus ulcers from the pressure. This abnormal posturing is an extrapyramidal effect and is caused by spasm of the axial muscles along the spine.

Opisthotonos is a symptom of several different medical conditions, in which the body is seized in an unusual posture. It most often involves severe arching of the back and rigidity, with the patient's head thrown backward. When a patient experiencing this abnormal posture lies on his or her back, only their heels and the back of their head will touch the supporting surface. Opisthotonos can affect both infants, children, and adults, but it far more common in infants and children. Part of the reason for it being more exaggerated in infants and children is due to their nervous systems being less mature.

Opisthotonos is a condition in which the body is held in an abnormal position. The person is usually rigid and arches the back, with the head thrown backward. If a person with opisthotonos lies on his or her back, only the back of the head and the heels touch the supporting surface.

The etiology of opisthotonos is not fully understood but most likely involves damage to inhibitory pathways of the brainstem and spinal cord, resulting in increased activity of extensor motorneurons.

Opisthotonos can be "set off" by any attempt at volitional movement including smiling, feeding and vocalization, or by seizure activity. Individuals with opithotonus are quite challenging to position, especially in wheelchairs and car seats.

Long-term sequelae of opisthotonos may include: early development of scoliosis, hip subluxation, pelvic obliquity, skin breakdown and mandibular malalignment.

Often, any movement that results in head and neck rotation/extension stimulates the individual's tonic bite reflex, resulting in lip and cheek biting. Some individuals rotate their heads so much that particular parts of their faces are frequently irritated. Skin breakdown on the cheek, ear and even the eye can result. These secondary changes may be affected by proper positioning in a seated position.

Other risk factors may include:

    Brain tumor.

  • Growth hormone deficiency (occasionally).

  • Glutaric aciduria and organic acidemias (forms of chemical poisoning).

  • Krabbe Disease (disorder of metabolism).

  • Meningitis.

  • Seizures.

  • Severe head injury.

  • Stiff-person syndrome (a condition that involves worsening rigidity and spasms).

  • Subarachnoid hemorrhage (bleeding in the brain).

  • Tetanus.

  • Arnold-Chiari syndrome (a brain structure problem).

  • Gaucher disease (disorder of metabolism).

Symptoms:

Symptoms may include the following:

    Spasms in jaw muscles.

  • Loss of coordination.

  • Twitches in the hand or foot.

  • Tremors and cramps.

  • Muscle pain.

  • Abnormal posture.

  • Anxiety, fatigue, and stress can worsen symptoms.

Diagnosis:

If opisthotonos is present, it needs to be evaluated immediately. Some of the causes, such as meningitis, seizures, bleeding in the brain, severe head injury, tetanus, and medication reactions, can be life-threatening. This issue tends to present as a later symptom of the conditions that cause it, making it even more crucial to seek emergency medical attention.

When you see a doctor to have opisthotonos evaluated, they will begin by taking a personal medical history and a physical exam in which they will evaluate the patient and their posture, and ask some basic questions about other symptoms, when the abnormal posture began, and if the posture is always the same. During the physical exam, the patient's nervous system will also be completely assessed.

Other diagnostic tests can include a CT scan of the head, urine and blood tests, a lumbar puncture, an MRI of the head, and an electrolyte analysis.

Treatment:

At the hospital, emergency treatment for opisthotonos must be started right away. This includes placing a breathing tube and providing breathing assistance. The person will likely be placed in the hospital intensive care unit.

Treatment option may include:

    Wait it out: Individual may gradually relax.

  • Return head to midline with chin tuck.

  • Massage the palms of hand with thumb in full abduction.

  • Avoid touching face and head.

  • Ask physician about benefits of spasticity reducing medications.

  • Use soft bracing for the trunk.

  • Place child high up so they are looking down at the action.

  • Place child in sidelying position for short period of time (20 minutes or less) while supported by towel rolls in flexion and as much anatomical alignment as possible.

  • Use slow stroking from neck to pelvis along the sides of the spine.

  • Use slow rhythmical movement.

  • Use slow rhythmical sounds.

  • Recognize the arching may be behavioral and deal with the behavior.

  • Recognize the arching may be that individual's mode of communicating and offer the child an alternative way to communicate (augmentative communication, switches, etc.).

  • Use a safety-tested and federally approved child restraint system whenever possible.

  • Place foam roll or rolled blanket under knees to break up the extension pattern.

  • Use a child safety seat with a five-point harness (at both shoulders, both hips and between the legs).

    If the child's head drops forward, wedge a cloth roll in the vehicle seat crease and under the child safety seat base at the child's feet, so that the child reclines to no more than a 45-degree angle.

  • For children who have poor head control and weigh more than 20 pounds, use a convertible seat that can be semireclined when facing forward. Soft padding may be positioned behind the neck and on either side of the head to promote anatomical alignment. This padding should not be placed behind the head itself or behind the trunk. Do not use head bands to restrain the child's head separately from the torso.

  • Only firm padding, such as a single folded sheet, should be used behind a child's back. No compressible padding should be placed behind or under the child in the seat. Soft padding (such as blankets, pillows, or soft foam) compress on impact and can prevent harness straps from maintaining a secure and tight fit on a child's body.

  • Head support should not contact base of skull.

  • Feet should be fully weight bearing and flat on the foot rest or floor.

  • Knees should be at 90 degrees with thigh fully supported.

  • Hips may need to be flexed to break up pattern.

  • A pummel or anti-thrust system may help keep the pelvis in alignment.

  • A low hip belt will help keep the pelvis aligned with the spine.

  • Lateral supports may keep the spine in alignment.

  • A chest harness may help the child sit in a regular classroom chair.

NOTE: The above information is for processing purpose. The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition.

DISCLAIMER: This information should not substitute for seeking responsible, professional medical care.

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