Definition

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 in the midbrain, which is between the brain and spinal cord. The midbrain regulates motor movement and many other important functions. Although decorticate posture is serious, it is usually not as serious as a type of abnormal posture called decerebrate posture.

The posturing may occur on one 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 illicit drugs, poisoning, or infection
• Traumatic brain injury
• Brain problem due to liver failure
• Increased pressure in the brain from any cause
• Brain tumor
• Infections, such as meningitis or encephalitis
• Reye syndrome (sudden brain damage and liver function problems that affects children)
• Brain injury from lack of oxygen

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 receive urgent medical attention.

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 be admitted to the intensive care unit.

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

Medical history questions may include:

• When did the symptoms start?
• Is there a pattern to the episodes?
• Is the body posturing always the same?
• Is there any history of illicit drug use, or a head injury, or other condition?
• 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 illicit 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
• Electroencephalogram (EEG) brain wave testing
• Intracranial pressure (ICP) monitoring
• Lumbar puncture to collect cerebrospinal fluid

The outlook depends on the cause. There may be brain and nervous system injury and permanent brain damage, which can lead to:

• Inability to communicate
• Paralysis
• Seizures
• Death
• Coma

References

Ball JW, Dains JE, Flynn JA, Solomon BS, Stewart RW. Neurologic system. In: Ball JW, Dains JE, Flynn JA, Solomon BS, Stewart RW, eds. Seidel's Guide to Physical Examination. 10th ed. Philadelphia, PA: Elsevier; 2023:chap 23.

Berger JR, Price R. Stupor and coma. In: Jankovic J, Mazziotta JC, Pomeroy SL, Newman NJ, eds. Bradley and Daroff's Neurology in Clinical Practice. 8th ed. Philadelphia, PA: Elsevier; 2022:chap 5.

Greer DM, Bernat JL. Coma, disorders of consciousness, and brain death. In: Goldman L, Cooney KA, eds. Goldman-Cecil Medicine. 27th ed. Philadelphia, PA: Elsevier; 2024:chap 373.

Hamati AI, Felkar MV. Neurological complications of systemic disease: children. In: Jankovic J, Mazziotta JC, Pomeroy SL, Newman NJ, eds. Bradley and Daroff's Neurology in Clinical Practice. 8th ed. Philadelphia, PA: Elsevier; 2022:chap 59.

Lei C, Smith C. Depressed consciousness and coma. In: Walls RM, ed. Rosen's Emergency Medicine: Concepts and Clinical Practice. 10th ed. Philadelphia, PA: Elsevier; 2023:chap 12.

Papa L, Goldberg SA. Head trauma. In: Walls RM, ed. Rosen's Emergency Medicine: Concepts and Clinical Practice. 10th ed. Philadelphia, PA: Elsevier; 2023:chap 33.