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Decorticate posture

 

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.

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 a type of abnormal posture called decerebrate posture.

The posturing may occur on 1 or both sides of the body.

Causes

 

Causes of decorticate posture include:

  • Bleeding in the brain from any cause
  • Brain stem tumor
  • Stroke
  • Brain problem due to drugs, poisoning, or infection
  • Head injury
  • Brain problem due to liver failure
  • Increased pressure in the brain from any cause
  • Primary brain tumor
  • Secondary brain tumor

 

When to Contact a Medical Professional

 

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 and treated right away in a hospital.

 

What to Expect at Your Office Visit

 

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

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

Medical history questions may include:

  • When did this behavior start?
  • Is there a pattern to the episodes?
  • 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)
  • MRI or CT scan 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

Ball JW, Dains JE, Flynn JA, Solomon BS, Stewart RW. Neurologic system. In: Ball JW, Dains JE, Flynn JA, Doloman BS, Stewart RW, eds. Seidel's Guide to Physical Examination. 8th ed. St. Louis, MO: Elsevier Mosby; 2015:chap 22.

Crocco TJ, Goldstein JN. Stroke. In: Marx JA, Hockberger RS, Walls RM, et al, eds. Rosen's Emergency Medicine: Concepts and Clinical Practice. 8th ed. Philadelphia, PA: Elsevier Mosby; 2013:chap 101.

Heegaard WG, Biros MH. Head injury. In: Marx JA, Hockberger RS, Walls RM, et al, eds. Rosen's Emergency Medicine: Concepts and Clinical Practice. 8th ed. Philadelphia, PA: Elsevier Mosby; 2013:chap 41.

Mihailoff GA, Haines DE. Motor system I. In: Haines DE, ed. Fundamental Neuroscience for Basic and Clinical Applications. Philadelphia, PA: Elsevier Saunders; 2013:chap 24.

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          Review Date: 6/1/2015

          Reviewed By: Daniel Kantor, MD, Kantor Neurology, Coconut Creek, FL and Immediate Past President of the Florida Society of Neurology (FSN). Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.

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