Decerebrate posture

Definition:

Decerebrate posture is an abnormal posturing exemplified by rigid extension of the arms with internal rotation, extension of the legs with internal rotation and downward pointing of the toes, and retraction (backward arching) of the head due to a severe injury to the brain at the level of the brainstem or diffuse cortical dysfunction.

Considerations:

Opisthotonos may accompany decerebrate posture in severe cases.

Usually, decerebrate posture indicates deterioration of the structures of the nervous system, particularly deterioration of the upper brain stem.

Decerebrate posture occurs in many patterns. It can occur on one side, on both sides, or in just the arms. It may alternate with decorticate posture, or a person can have decorticate posture on one side and decerebrate posture on the other.

Common Causes:

Cerebral infarction (stroke)
Intracranial hemorrhage
Primary brain tumor
Secondary brain tumor
Encephalopathy
Head injury
Increased intracranial pressure from any cause
Brain stem tumor
Hepatic encephalopathy

Home Care:

Conditions associated with decerebrate posture require immediate hospital treatment.

Call your health care provider if:

Abnormal posturing (of any sort) usually accompanies reduced consciousness. Anyone exhibiting an abnormal posture should be examined promptly by the health care provider.

Note: In some conditions such as prolonged coma, 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 hospitalized and in intensive care. Once the person is stabilized, the medical history will be obtained from family members and a physical examination will be performed.

Medical history questions documenting decerebrate posture in detail may include:

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

The physical examination will include a complete neurological assessment.

Diagnostic testing may include:

Cerebral angiography
CT or MRI of the head
EEG
Brain scan
ICP monitoring

Review Date: 7/14/2001
Reviewed By: Galit Kleiner-Fisman, M.D., FRCP, Department of Neurology, Toronto Western Hospital and the University of Toronto, Toronto, Canada. Review provided by VeriMed Healthcare Network.

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