Decerebrate posture

Answer 1

Definition

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.

Considerations

A 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 Causes

• Cerebral infarction (stroke)
• Bleeding in the brain from any cause (Intracranial hemorrhage)
• Primary brain tumor
• Secondary brain tumor
• Encephalopathy (brain dysfunction due to drugs, poisoning, or infection)
• Head injury
• Increased pressure in the brain from any cause
• Brain stem tumor
• Hepatic encephalopathy (brain dysfunction due to liver failure)

Home Care

Conditions associated with decerebrate posture require immediate hospital treatment.

Call your health care provider if

Abnormal 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 office

Emergency 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:

• When did this behavior start?
• Is there a pattern to the occurrences?
• Is it always the same type of posture?
• Is there any significant medical history (such as a known head injury)?
• What other symptoms preceded or accompanied the abnormal posturing?

Diagnostic testing may include:

• Blood tests to check blood counts, measure body chemicals and minerals, and to screen for drugs and toxic substances
• Cerebral angiography
• CT or MRI of the head
• EEG
• ICP monitoring

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.

Answer 2

Definition

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.

Considerations

A severe injury to the brain is the usual cause of decerebrate posture.

Opisthotonos (a severe muscle spasm of the neck and back) may occur in severe cases of decerebrate posture.

Decerebrate posture can occur on one side, on both sides, or in just the arms. It may alternate with decorticate posture. A person can also have decorticate posture on one side of the body and decerebrate posture on the other side.

Common Causes

• Bleeding in the brain from any cause (intracranial hemorrhage)
• Brain stem tumor
• Cerebral infarction (stroke)
• Encephalopathy (brain problem due to drugs, poisoning, or infection)
• Head injury
• Hepatic encephalopathy (brain problem due to liver failure)
• Increased pressure in the brain from any cause
• Primary brain tumor
• Secondary brain tumor

Home Care

Conditions related to decerebrate posture need to be treated right away in a hospital.

Call your health care provider if

Abnormal posturing of any kind usually occurs with a reduced level of alertness. Anyone who has an abnormal posture should be examined right away by a health care provider.

What to expect at your health care provider's office

The person may need emergency treatment right away. 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 stable, the health care provider will do a more complete physical exam, including a brain and nervous system assessment.

Family members will be asked questions about the person's medical history, including:

• When did this behavior start?
• Is there a pattern to the occurrences?
• Is it always the same type of posture?
• Is there any history of a head injury or other condition?
• What other symptoms came before or with the abnormal posturing?

Tests may include:

• Blood and urine tests to check blood counts, screen for drugs and toxic substances, and measure body chemicals and minerals
• Cerebral angiography (dye and x-ray study of blood vessels in the brain)
• CT or MRI of the head
• EEG (brain wave testing)
• Intracranial pressure (ICP) monitoring

The outlook depends on the cause. There may be brain and nervous system injury and permanent brain damage, which can lead to:

• Coma
• Inability to communicate
• Paralysis
• Seizures

References

Mayer SA, Badjatia N. Head injury. In: Wolfson AB, Hendey GW, Ling LJ, et al, eds. Harwood-Nuss' Clinical Practice of Emergency Medicine. 5th ed. Philadelphia, Pa: Lippincott Williams & Wilkins; 2009:chap 70.

Reviewed By

Review Date: 04/05/2011

Jacob L. Heller, MD, MHA, Emergency Medicine, Virginia Mason Medical Center, Seattle, Washington. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.