Opisthotonos: Causes, Symptoms, and Treatment
Medically reviewed by Harsha Moole, MD, Internal Medicine. Last reviewed: October 23, 2026.
What kind of doctor treats Opisthotonos?
Opisthotonos is evaluated in a hospital, where emergency measures may be taken. An emergency room doctor, who treats sudden and serious problems, is usually the first to see it. A neurologist, a doctor who treats brain and nerve problems, often helps find the cause. A direct primary care or concierge doctor can be a first stop for an evaluation and can refer you to a specialist when needed.
What is opisthotonos?
Opisthotonos is a condition in which a person holds their body in an abnormal position. The person is usually rigid and arches their back, with their head thrown backward.
If a person with opisthotonos lies on their back, only the back of their head and their heels touch the surface. It is much more common in infants and children than in adults. It is also more extreme in infants and children because their nervous systems are less mature. Opisthotonos is usually a symptom of another condition that is serious enough for a person to need medical care.
Symptoms
The main sign of opisthotonos is the body position itself.
- The body is usually rigid.
- The back is arched.
- The head is thrown backward.
Other symptoms may come before or along with the unusual position. Doctors ask about signs such as fever, stiff neck, or headache. When tetanus is the cause, back muscle spasms often make the spine arch.
Causes and who gets it
Opisthotonos may occur in infants with meningitis, an infection of the meninges, the membranes that cover the brain and spinal cord. Viruses, malaria, and syphilis are infections linked to opisthotonos. It may also be a sign of reduced brain function or injury to the nervous system.
Other causes may include:
- Brain tumor.
- Cerebral palsy.
- Seizures.
- Traumatic brain injury.
- Bleeding in the brain.
- Tetanus.
- Arnold-Chiari syndrome, a problem with the structure of the brain.
- Gaucher disease, which causes a buildup of fatty tissue in certain organs.
- Stiff-person syndrome, a condition that makes a person rigid and have spasms.
- Poisoning, including strychnine, some street drugs, and some medicines.
- Metabolic disorders that run in families, such as maple syrup urine disease.
Some antipsychotic medicines can cause a side effect called acute dystonic reaction, and opisthotonos may be part of it. In rare cases, infants born to women who drink large amounts of alcohol during pregnancy may have opisthotonos due to alcohol withdrawal. Tetanus is an infection with a type of bacteria that is potentially deadly. You can get tetanus when the spores of the bacteria enter your body through an injury or wound. Nearly all cases of tetanus in the United States occur in people who have not been vaccinated against the disease.
How doctors diagnose it
Your health care provider will do a physical exam and ask about symptoms to look for the cause of opisthotonos. The exam includes a complete checkup of the nervous system.
Questions may include when the symptoms started and whether the body position is always the same. Doctors may also ask about any recent history of illness. Tests may include:
- Blood and urine tests.
- A CT scan of the head.
- An MRI of the brain.
- A lumbar puncture, also called a spinal tap.
- Tests of the fluid around the brain and spinal cord (cerebrospinal fluid), including a culture and cell counts.
No specific lab test is available to diagnose tetanus.
Treatment
Treatment depends on the cause. For example, if meningitis is the cause, medicines may be given. A person who develops opisthotonos will need to be checked at a hospital and may need to be admitted for care.
When tetanus is the cause, treatment may include antibiotics, bed rest in a calm environment, and medicine to neutralize the poison. Muscle relaxers and sedatives may also be used. Breathing support may be necessary.
When to see a doctor
Go to the emergency room or call 911 or the local emergency number if symptoms of opisthotonos occur. This is because opisthotonos is typically a symptom of other conditions that are serious enough for a person to seek medical attention.
How a direct primary care or concierge doctor fits in
A direct primary care doctor charges a flat monthly fee instead of billing insurance, while a concierge doctor usually charges more and often works alongside insurance. After a hospital stay, either type of doctor can arrange follow-up visits and help coordinate care with specialists.
Common questions
Is opisthotonos serious?
Yes, it is usually a sign of another serious condition. A person who has it will need to be checked at a hospital.
Is opisthotonos more common in children than in adults?
Yes, it is much more common in infants and children than in adults. It is also more extreme in infants and children because their nervous systems are less mature.
What causes opisthotonos?
Many different problems can cause it, so doctors look for the cause. Causes include meningitis, brain tumor, cerebral palsy, seizures, poisoning, traumatic brain injury, and tetanus.
Does tetanus cause opisthotonos?
Yes, it can. In tetanus, back muscle spasms often make the spine arch. Nearly all cases of tetanus in the United States occur in people who have not been vaccinated against the disease.
Should I go to the emergency room for opisthotonos?
Yes, go to the emergency room or call 911 or the local emergency number.
Sources
Medical Disclaimer
This content is for general educational and informational purposes only and is not medical advice. It is not a substitute for professional medical advice, diagnosis, or treatment, and reading it does not create a doctor-patient relationship. Always seek the advice of your physician or another qualified health provider with any questions about a medical condition, and never disregard or delay seeking professional advice because of something you read here. If you think you may have a medical emergency, call 911 (or your local emergency number) immediately.
