Decerebrate posture is an abnormal body posture that involves the arms and legs being held straight out, the toes being pointed downward, and the head and neck being arched backwards. The muscles are tightened and held rigidly. This type of posturing usually means there has been severe damage to the brain.
ConsiderationsA severe injury to the brain at the level of the brainstem is the usual cause of decerebrate posture.
Opisthotonos (a severe muscle spasm of the neck and back) may accompany decerebrate posture in severe cases.
Decerebrate posture can occur on one side, on both sides, or in just the arms. It may alternate with decorticate posture(abnormal posturing due to corticospinal tract injury), or a person can have decorticate posture on one side and decerebrate posture on the other.
Common CausesConditions associated with decerebrate posture require immediate hospital treatment.
Call your health care provider ifAbnormal posturing of any sort is usually associated with reduced level of consciousness (alertness). Anyone who has an abnormal posture should be examined promptly by a health care provider.
What to expect at your health care provider's officeEmergency measures may begin immediately. This includes breathing assistance and placement of a breathing tube. The person will likely be admitted to the hospital and placed in intensive care.
Once the person is stabilized, the health care provider will perform a more extensive physical exam. The physical exam will include a complete neurological assessment.
Family members will be asked questions about the person's medical history, including:
Diagnostic testing may include:
The outlook depends on the cause. Permanent brain damage may often result, leading to long-term neurologic deficits such as coma, inability to communicate, paralysis, or seizures.
Grade IV: Child is in a deepening coma, experiencing seizures, pupils nonresponsive to light, has abnormal reflexes, is in decerebrate posture (stiff, rigid posture indicative of severe damage to brain stem).
Decerebrate posture is generally considered worse. Decerebrate posturing is characterized by adduction, internal rotation, and extension of the arms with the writs pronated and the fingers flexed. The legs are stiffly extended and the feet are in plantar flexion. Sometimes, in more severe cases, the back may be arched. This posture indicates damage damage to the upper brain stem, which could result from direct injury, or primary lesions like infarction, hemorrhage, or tumor; or other causes. Decorticate posture is characterized by adduction AND flexion of the arms (in decerebrate the arms are straight, and the wrists and fingers are flexed on the chest, seeming to mimic a protective position. The legs are extended and internally rotated (feet turned inward toward each other), and the feet are in plantar flexion. This can occur on only one side or both sides. This position usually results from a head injury or a stroke and it indicates corticopsinal damage, which means the nerves that carry impulses from the cerebral cortex to the brain are damaged. It is very serious, but it generally has a more favorable prognosis than decerebrate posturing. However, it is possible for decorticate posturing to progress to decerebrate posture if the damage is near enough the brain stem.
Decorticate rigidity and decerebrate rigidity are both types of abnormal posturing seen in patients with brain injuries. Decorticate rigidity involves flexion of the arms and wrists, while decerebrate rigidity involves extension of the arms and wrists. Decorticate rigidity is typically associated with damage to the cerebral hemispheres, while decerebrate rigidity is associated with damage to the brainstem. The underlying neurological mechanisms involve disruption of different pathways within the brain, leading to distinct patterns of muscle tone and posture.
Grade V: Child is in a deep coma, pupils are fixed and dilated (abnormally enlarged, do not constrict when exposed to light), no normal reflexes, alternates between decerebrate posture and completely limp, flaccid muscles.
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