STUDY - Technical - New Dacian's Medicine
Opisthotonos
(Classical / Allopathic Medicine)
A
sign of severe meningeal irritation, opisthotonos is
characterized by a strongly arched, rigid back; a
hyperextended neck; heels that are bent back; and arms and
hands that are flexed at the joints. Usually, this posture
occurs spontaneously as well as continuously; however, it
may be aggravated by movement. Because it immobilizes the
spine, opisthotonos presumably represents a protective
reflex that alleviates pain associated with meningeal
irritation.
Usually
caused by meningitis, opisthotonos may also result from
subarachnoid hemorrhage, Arnold-Chiari syndrome, or
tetanus. Occasionally, it occurs with achondroplastic
dwarfism, although not necessarily as an indicator of
meningeal irritation.
Opisthotonos
is far more common in children - especially infants - than
in adults. It's also more exaggerated in children because
of nervous system immaturity. (See Opisthotonos: Sign of
meningeal irritation.)
ALERT:
If the patient is stuporous or comatose:
- quickly take his vital signs
- take seizure precautions; if meningitis is suspected, institute respiratory isolation
- initiate emergency measures, if necessary.
If the patient's condition permits, perform a focused assessment.
If the patient is stuporous or comatose:
- quickly take his vital signs
- take seizure precautions; if meningitis is suspected, institute respiratory isolation
- initiate emergency measures, if necessary.
If the patient's condition permits, perform a focused assessment.
HISTORY:
Review the patient's medical history for cerebral aneurysm, arteriovenous malformation, and hypertension.
Note recent infections that may have spread to the nervous system.
Explore associated signs and symptoms, such as headache, chills, and vomiting.
Review the patient's medical history for cerebral aneurysm, arteriovenous malformation, and hypertension.
Note recent infections that may have spread to the nervous system.
Explore associated signs and symptoms, such as headache, chills, and vomiting.
Opisthotonos:
Sign of meningeal irritation
With opisthotonos, the back is severely arched and the neck is hyperextended. The heels bend back on the legs, and the arms and hands flex rigidly at the joints, as shown.
PHYSICAL ASSESSMENT:
Evaluate the level of consciousness, and test sensorimotor and cranial nerve function.
Check for Brudzinski's and Kernig's signs and for nuchal rigidity.
With opisthotonos, the back is severely arched and the neck is hyperextended. The heels bend back on the legs, and the arms and hands flex rigidly at the joints, as shown.
PHYSICAL ASSESSMENT:
Evaluate the level of consciousness, and test sensorimotor and cranial nerve function.
Check for Brudzinski's and Kernig's signs and for nuchal rigidity.
SPECIAL
CONSIDERATIONS:
Phenothiazines and other antipsychotics may cause opisthotonos, usually as part of an acute dystonic reaction. This can usually be treated with I.V. diphenhydramine.
Phenothiazines and other antipsychotics may cause opisthotonos, usually as part of an acute dystonic reaction. This can usually be treated with I.V. diphenhydramine.
PATIENT
COUNSELING:
Instruct the patient on what to expect from diagnostic testing, which may include lumbar puncture, computed tomography scan, and magnetic resonance imaging.
Instruct the patient on what to expect from diagnostic testing, which may include lumbar puncture, computed tomography scan, and magnetic resonance imaging.
Bibliography:
1. Rapid Assessment, A
Flowchart Guide to Evaluating Signs & Symptoms, Lippincott
Williams & Wilkins, 2004.
2. Professional Guide to
Signs and symptoms, Edition V, Lippincott
Williams & Wilkins, 2007.
3. Guide to common symptoms,
Edition V, McGraw - Hill, 2002.