Decorticate posture

Answer 1

Definition

Decorticate posture is an abnormal posturing that involves rigidity, flexion of the arms, clenched fists, and extended legs (held out straight). The arms are bent inward toward the body with the wrists and fingers bent and held on the chest.

This type of posturing is a sign of severe damage to the brain. It requires immediate medical attention.

Considerations

Decorticate posture indicates damage to the corticospinal tract, the pathway between the brain and spinal cord. Although a serious sign, it is usually more favorable than decerebrate posture.

Decorticate posture may progress to decerebrate posture, or the two may alternate. The posturing may occur on one or both sides of the body.

Common Causes

• Stroke
• Bleeding in the brain (intracranial hemorrhage)
• Primary brain tumor
• Secondary brain tumor
• Encephalopathy
• Head injury
• Increased intracranial pressure from any cause
• Brain stem tumor
• Liver-induced brain dysfunction (hepatic encephalopathy)

Home Care

Conditions associated with decorticate 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.

If associated with prolonged coma (unconsciousness), these behaviors can persist for an extended period of time.

What to expect at your health care provider's office

Emergency measures may begin immediately, including placement of an artificial airway (breathing tube) and assistance with breathing. The person will likely be admitted to the hospital and placed in intensive care.

After the condition is stabilized, the medical history will be obtained from family members and a more extensive physical examination will be done. The physical exam will include a detailed assessment of the nervous system.

Medical history questions may include:

• 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 or drug use)?
• What other symptoms came before or alone with the abnormal posturing?

Tests that may be done include:

• Blood and urine tests to check blood counts, screen for drugs and toxic substances, and measure body chemical and minerals
• Head MRI or CT scan
• Cerebral angiography
• EEG
• ICP monitoring

The outlook depends on the cause of the posturing. Neurologic injury and brain damage may often result, leaving the person with persistent neurological deficits such as coma, inability to communicate, paralysis, or seizures.

References

Mayer SA. Head injury. In: Rowland LP, ed. Merritt's Neurology. 11th ed. Baltimore, Md: Lippincott Williams & Wilkins; 2005:chap 64.

Answer 2

Definition

Decorticate posture is an abnormal posturing in which a person is stiff with bent arms, clenched fists, and legs held out straight. The arms are bent in toward the body and the wrists and fingers are bent and held on the chest.

This type of posturing is a sign of severe damage in the brain. People who have this condition should get medical attention right away.

Considerations

Decorticate posture is a sign of damage to the nerve pathway between the brain and spinal cord. Although it is serious, it is usually not as serious as decerebrate posture.

The posturing may occur on one or both sides of the body.

Common Causes

• Bleeding in the brain (intracranial hemorrhage)
• Brain tumor
• Head injury
• Increased intracranial pressure from any cause
• Stroke
• Worsening of brain function that occurs from liver damage, infections in the brain, and other causes

Home Care

The conditions that cause decorticate posture need to be treated in a hospital right away.

What to expect at your health care provider's office

The person will receive emergency treatment right away. This includes getting a breathing tube and breathing assistance. The person will likely be admitted to the hospital and placed in intensive care.

After the condition is stable, the health care provider will get a medical history from family members and a more detailed physical examination will be done. This will include a careful examination of the nervous system.

Medical history questions may include:

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

Tests that may be done include:

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

The outlook depends on the cause of the posturing. There may be injury or damage to the brain or nervous system, which can leave the person with long-term problems such as:

• Coma
• Inability to communicate
• Paralysis
• Seizures

References

Mayer SA. Head injury. In: Rowland LP, ed. Merritt's Neurology. 11th ed. Baltimore, Md: Lippincott Williams & Wilkins; 2005:chap 64.

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: 04/03/2011

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