Decerebrate posture

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 is the usual cause of decerebrate posture.

Opisthotonos (a severe muscle spasm of the neck and back) may occur in severe cases of decerebrate posture.

Decerebrate posture can occur on one side, on both sides, or in just the arms. It may alternate with decorticate posture. A person can also have decorticate posture on one side of the body and decerebrate posture on the other side.

Causes of Decerebrate posture

• 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 from any cause
• Primary brain tumor
• Secondary brain tumor

Home Care

Conditions related to decerebrate posture need to be treated right away in a hospital.

When to Contact a Health 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.

The person may need emergency treatment right away. 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 stable, the health care provider will do a more complete physical exam, including a brain and nervous system 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 history of a head injury or other condition?
• What other symptoms came before or with the abnormal posturing?

Tests may include:

• Blood and urine tests to check blood counts, screen for drugs and toxic substances, and measure body chemicals and minerals
• Cerebral angiography (dye and x-ray study of blood vessels in the brain)
• CT or MRI 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

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.

Review Date: 4/5/2011
Reviewed By: Jacob L. Heller, MD, MHA, Emergency Medicine, Virginia Mason Medical Center, Seattle, Washington. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.

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