Clearly, since it is a symptom, the resolution of the opisthotonus is closely related to the cure or treatment of the underlying cause that triggered it.
of excitability of the motor cells of the spinal cord. The consequence of such alterations and / or induced lesions consists in the marked contraction of the skeletal muscles located along the vertebral column and in the onset of opisthotonus.Opisthotonus as a Symptom of Pathologies
As mentioned, the "opisthotonus can manifest itself as a symptom of some pathologies, among which we remember:
- Tetanus: Tetanus is a serious bacterial disease caused by a toxin released by the bacteria Clostridium tetani. This toxin is able to hinder the activity of two neurotransmitters with inhibitory function - such as glycine and GABA - favoring the contraction of striated muscles with the consequent appearance of spasms, rigidity and, in fact, opisthotonus.
- Meningitis: opisthotonus is also a typical symptom of some forms of meningitis, that is of particular inflammatory pathologies of the meninges (the lining membranes of the central nervous system with a protective function against the brain and spinal cord). In particular, opisthotonus seems to occur mainly in children affected by this disease.
- Arnold-Chiari syndrome: this is a pathology characterized by a malformation of the posterior cranial fossa. There are four different types of this syndrome, each with its own symptomatology. Opisthotonus tends to manifest itself in particular in type II Arnold-Chiari syndrome, a symptomatic form from birth.
- Neonatal jaundice: opisthotonus also occurs in newborns with jaundice. The symptom is induced by the accumulation of bilirubin in the basal nuclei.
- Maple Syrup Urine Disease: This is a rare autosomal recessive genetic disease characterized by a deficiency of the branched-chain alpha-ketoacid dehydrogenase enzyme. The disease manifests itself from early childhood with the appearance of various symptoms, including opisthotonus.
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Opisthotonus can also occur following the interruption of cardio-respiratory support in individuals diagnosed with irreversible coma.
Opisthotonus as a consequence of poisoning or poisoning
In some cases, opisthotonus may not represent a symptom of a disease, but rather the consequence of poisoning or intoxication. Among the substances that can give rise to poisonings or intoxications capable of triggering opisthotonus, we remember:
- Strychnine: is a very toxic alkaloid contained within the seeds of plants belonging to the genus Strychnos. Severe strychnine poisoning can give rise to opisthotonus. The symptom is due to competitive antagonist activity against glycine, an inhibitory neurotransmitter of the central nervous system. Due to this activity, strychnine prevents glycine from binding to its receptors, resulting in the onset of muscle contractions and opisthotonus.
- Ignatia amara and nux vomica: they are plants belonging to the genus Strychnos, therefore containing strychnine and other toxic alkaloids such as brucin. The intake of these plants, their seeds or derivatives of any type, therefore, is capable of giving rise to poisoning or intoxication which, in turn, can cause opisthotonus.
- Lithium: in some cases, opisthotonus can also occur in the presence of lithium intoxication.
Opisthotonus as a side effect of drugs
Sometimes, opisthotonus can occur after taking certain types of drugs. There are several active ingredients for which opisthotonus constitutes a known side effect; among these we remember:
- Levomepromazine, an antipsychotic drug used in the treatment of schizophrenia, paranoid states, mania, toxic psychosis and delusions. It is also used against nausea and incoercible hiccups and in case of very intense pain in association with analgesics.
- Chlorpromazine and perphenazine, other antipsychotics with therapeutic indications similar to those of the aforementioned levomepromazine.
- Clotiapine, an atypical antipsychotic used in the treatment of acute and chronic psychosis.
- Risperidone, another antipsychotic active ingredient used in the treatment of schizophrenia, mania and aggression in patients with Alzheimer's disease.
- L "oxatomide, an antihistamine used in the treatment and prevention of various allergic disorders, such as rhinitis, asthma, conjunctivitis, atopic dermatitis and food allergies.
Other Causes
In conclusion, we remind you that, in some cases, opisthotonus can occur following more or less severe traumatic brain injuries.
- assumes an "arched" or "bridge" position in which only the head (possibly, together with the neck and shoulders) and the heels are in contact with the support base on which it is located.
The contraction and muscle stiffness that characterize the opisthotonus can be accompanied by a more or less intense sensation of pain, which varies according to the cause that triggered the symptom.
In some cases, the opisthotonus can also be associated with an extension of the four limbs (decerebrate rigidity).
Finally, depending on the cause that gave rise to the opisthotonus, the patient may also manifest other characteristic symptoms (for example, very high fever in the case of meningitis; jaw stiffness in the presence of tetanus; convulsions and difficulty walking in the case of the syndrome Arnold-Chiari type II; agitation, restlessness and muscle spasms in case of strychnine poisoning; etc.).
Factors that favor the appearance of opisthotonus
In the presence of one of the triggering causes, the opisthotonus can manifest itself following stimuli of different types - such as tactile, visual or acoustic stimuli - or following any attempt to move (nods of the head, attempt to grasp objects and even , attempt to speak, smile or eat).
, CT scan, MRI, etc.
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