Causes and Management of Opisthotonus
Opisthotonos refers to severe spams of the extensor muscles of back, neck, and lower limbs, resulting in backward arching of back, which sometimes even results in lifting of back from the surface. It is a variant of decerebrate posture. Etiology of opisthotonos is vast, ranging from infections, to poisoning, developmental and metabolic disorders, as well as increased intracranial pressure and psychogenic causes. The list of possible causes of opisthotonos is as follows: 1. INFECTIOUS CAUSES - Tetanus - Meningitis - Cerebral malaria - Rabies - Neurosyphilis - Encephalitis 2. POISONS AND SRUGS - Strychnine - Phenothiazines - Methoxphenidine - Lignocaine - Propofol (rare) 3. METABOLIC AND DEVELOPMENTAL DISORDER - Cerebral palsy - Krabbe disease - Kernicterus - Gaucher disease - Infant alcohol withdrawal syndrome 4. INCREASED INTRACRANIAL PRESSURE - Space-occupying lesion - Subarachnoid hemorrhage - Hydrocephalus - Intracranial hemorrhage 5. NEURODEGENRATIVE SYNDROME - Wilson disease - Lesch-Nehan syndrome - Parkinson’s disease 6. PSYCHOGENIC DYSTONIA - Hysteria 7. ANOXIC INJURY - Cardiac arrest - Suffocation - Birth asphyxia 8. MISCELLANEOUS - Dandy-Walker malformation - Stiff person syndrome MANAGEMENT Management plan is based on treatment of underlying cause of opisthotonos. Ventilatory and nutritional support may be provided. Fluid management is also important. It is imperative to avoid exposure to triggering factors of opisthotonos. Administration of benzodiazepines orally or baclofen intrathecally can reduce spasms. Source Opisthotonus https://www.ncbi.nlm.nih.gov/books/NBK559170/ Image via https://www.medicalnewstoday.com/articles/318868
Can a patient take oral medication in such situation? As you mentioned oral benzodiazepines administration.
Hello! Oral benzodiazepines can be administered in the absence of spasm to reduce the intensity of future spasms until the underlying cause is treated. Baclofen cannot be administered orally due to poor penetration through blood-brain barrier.
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