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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.

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.

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 (intracranial hypertension) 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.

What to Expect at Your Office Visit

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 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 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:

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. 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.

Brust JCM. Coma. In Rowland LP, Merritt HH, eds. Merritt's Neurology. 12th ed. Baltimore, Md: Lippincott Williams & Wilkins; 2009:chap 6.

Updated: 4/5/2013

Jacob L. Heller, MD, MHA, Emergency Medicine, Virginia Mason Medical Center, Seattle, Washington. Also reviewed by A.D.A.M. Health Solutions, Ebix, Inc., Editorial Team: David Zieve, MD, MHA, Bethanne Black, Stephanie Slon, and Nissi Wang.


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