Decerebrate posture

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.

Review Date: 4/21/2009

Reviewed by: 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.

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