Decorticate Posturing

What is decorticate posturing?

Decorticate posturing is a pose that your body may hold automatically because of damage to or disruptions in your brain. It’s a symptom of brain injuries and many different medical conditions.

Decorticate posturing causes certain muscle groups throughout your body to reflexively tense up. It can affect one side of the body or both. However, when it affects both sides, it isn’t always consistent. It may affect both sides of the body unevenly.

Decorticate posturing is a reflex. The movements it involves aren’t like the uncontrolled movements of a seizure. Instead, it’s usually a response to uncomfortable sensations (which is part of testing reflexes in a neurological exam).

A person with decorticate posturing can have the following:

• Extended and rigid legs.
• Toes pointed away from the body and turned slightly inward.
• Arms bent upward at the elbows toward the center of your body.
• Curled wrists.
• Hands balled and pressed together and against the chest.

Decorticate posturing is one of the indicators that healthcare providers use when assessing coma using the Glasgow Coma Scale. People who have this are always unconscious and unresponsive. That means they don’t wake up or respond, even with repeated efforts to rouse them.

What are the most common causes of decorticate posturing?

Having decorticate posturing often indicates problems or damage in certain brain areas. Some of the areas it can involve are:

• The upper midbrain. This area is the topmost section of the brainstem, a critical brain structure that links the rest of your brain to your spinal cord.
• The cerebral cortex. This is the wrinkly, outermost layer of the cerebrum. The term cortex comes from the Latin word meaning “tree bark.” The cerebral cortex is where most of the thinking and processing work happens in your brain.
• The thalamus. This egg-shaped structure in the center of your brain relays signals traveling between different brain areas. It’s one of the main junctions handling signals that travel to and from the cerebral cortex.

Conditions that can cause decorticate posturing include (but aren’t limited to) the following:

• Concussions and traumatic brain injuries (TBIs).
• Strokes.
• Brain bleeds (intracranial hemorrhage).
• Brain tumors (including cancer), especially ones that affect the brainstem.
• Infections like meningitis, encephalitis or very severe cases of malaria.
• Increased pressure inside the skull (intracranial hypertension).
• Hydrocephalus.
• Cerebral hypoxia.
• Severe alcohol intoxication or drug overdose.
• Lead poisoning.
• Reye’s syndrome.
• Hypoglycemia.
• Hepatic encephalopathy.

How is decorticate posturing treated?

Decorticate posturing is a symptom that isn’t treatable directly. However, treating a condition that’s causing it may be possible.

In addition to treating the underlying cause, there are other likely forms of care that a person with decorticate posturing may receive. People with this symptom are unconscious or in a coma and may need supportive treatment. An example of supportive treatment is mechanical ventilation to help them breathe.

Because there are so many possible causes, the treatment options can vary. A healthcare provider is the best person to tell you about treatment options and which ones they recommend.

What are the possible complications or risks of not treating decorticate posturing?

Decorticate posturing is usually a sign of damage to the brain or severe disruptions in brain activity. Many of the conditions that cause it are deadly without treatment. Delays in treatment can also result in permanent damage. When permanent damage happens, the abilities once controlled by the damaged areas may be severely disrupted or permanently lost.

Can decorticate posturing be prevented?

Many causes of decorticate posturing are preventable. Some happen unpredictably or for reasons experts don’t fully understand, so preventing this symptom isn’t always possible. However, there are some things you can do to lower your risk of developing conditions that can lead to decorticate posturing.

Steps you can take include:

• Manage your chronic conditions. Follow your healthcare provider’s guidance on managing chronic conditions like diabetes, high blood pressure and epilepsy.
• Wear safety equipment as needed. Head injuries, especially concussions and traumatic brain injuries, are among the most common causes of decorticate posturing. Protect your brain from injury using safety equipment, like helmets and seat belts.
• Eat a balanced diet. Electrolyte imbalances and nutrient deficiencies are often avoidable (or you can reduce the risk of having them). Managing what you eat can also help avoid decorticate posturing related to many brain-related conditions, especially strokes.
• Stay physically active, and reach and maintain a weight that’s healthy for you. Your weight and activity levels can prevent or delay conditions that affect your brain. Healthcare providers can guide you on reaching and maintaining a weight that’s healthy for you.
• Avoid substance and nonmedical drug use, and use moderation when drinking alcohol-containing beverages. Substance use disorders can be an underlying cause of decorticate posturing. Always take prescription medications exactly as directed and avoid nonmedical drug and substance use. Moderate alcohol use is no more than two drinks per day for men and people assigned male at birth (AMAB) and no more than one drink per day for women and people assigned female at birth (AFAB).
• Seek treatment for infections. Many infections that affect your brain start in nearby places like your eyes, nose or ears. Don’t delay treatment for infections in these areas. Prompt treatment can help you avoid the spread of infections, which can lead to problems like decorticate posturing.

When should decorticate posturing be treated by a doctor or healthcare provider?

A person with uncontrolled muscle movements of any kind when unconscious and unresponsive (meaning they don’t wake up when you try to rouse them) needs immediate medical care. Call 911 (or your local emergency services number) right away.

Decorticate posturing vs. decerebrate posturing — what’s the difference?

Decorticate posturing and decerebrate posturing look very much alike. A trained healthcare provider should be the one to diagnose either of them. Even trained, experienced clinicians may find it challenging to diagnose them.

Generally, decorticate posturing is less severe than decerebrate posturing. The main difference between the two postures is whether or not the arms are bent at the elbow. A person whose elbows bend and fold their arms up toward their chest has decorticate posturing. A person whose limbs all extend away from their head has decerebrate posturing.

Is recovery from a condition that causes decorticate posturing possible?

Many of the conditions that cause decorticate posturing are treatable or reversible, especially conditions like hypoglycemia. The underlying cause is one of the biggest factors when determining the odds of survival and recovery.

A note from Cleveland Clinic

Having a loved one who has decorticate posturing can be a frightening experience. People who have this are unconscious and in a coma. This symptom is a key indicator of conditions that damage the brain or disrupt brain processes.

However, this symptom doesn’t mean there’s no hope for survival or recovery. Modern medical advances mean that treatment options are possible for many brain conditions that can cause decorticate posturing. The odds are ever-improving, and there’s hope for many people with this symptom now and in the future.