Decorticate posture [Decorticate rigidity, abnormal flexor response]

Decorticate posture [Decorticate rigidity, abnormal flexor response]: Excerpt from Nursing: Interpreting Signs and Symptoms

A sign of corticospinal damage, decorticate posture is characterized by adduction of the arms and flexion of the elbows, with wrists and fingers flexed on the chest. The legs are extended and internally rotated, with plantar flexion of the feet. This posture may occur unilaterally or bilaterally. It usually results from stroke or head injury. It may be elicited by noxious stimuli or may occur spontaneously. The intensity of the required stimulus, the duration of the posture, and the frequency of spontaneous episodes vary with the severity and location of cerebral injury.

Although a serious sign, decorticate posture carries a more favorable prognosis than decerebrate posture. However, if the causative disorder extends lower in the brain stem, decorticate posture may progress to decerebrate posture. (See Comparing decerebrate and decorticate postures.)

Action stat!

Obtain the patient's vital signs and evaluate his level of consciousness (LOC). If his consciousness is impaired, insert an oropharyngeal airway, and take measures to prevent aspiration (unless spinal cord injury is suspected). Evaluate the patient's respiratory rate, rhythm, and depth. Prepare to assist respirations with a handheld resuscitation bag or with endotracheal intubation and mechanical ventilation if necessary. Institute seizure precautions.

History and physical examination

Test the patient's motor and sensory functions. Evaluate pupil size, equality, and response to light. Then test cranial nerve function and deep tendon reflexes. Ask the patient about headache, dizziness, nausea, changes in vision, and numbness or tingling. When did the patient first notice these symptoms? Is his family aware of behavioral changes? Also ask about a history of cerebrovascular disease, cancer, meningitis, encephalitis, upper respiratory tract infection, bleeding or clotting disorders, or recent trauma.

Medical causes

Brain abscess.Decorticate posture may occur with brain abscess. Accompanying findings vary depending on the size and location of the abscess, but may include aphasia, hemiparesis, a headache, dizziness, seizures, nausea, and vomiting. The patient may also experience behavioral changes, altered vital signs, and a decreased LOC.

Brain tumor.A brain tumor may produce decorticate posture that's usually bilateral—the result of increased intracranial pressure (ICP) associated with tumor growth. Related signs and symptoms include a headache, behavioral changes, memory loss, diplopia, blurred vision or vision loss, seizures, ataxia, dizziness, apraxia, aphasia, paresis, sensory loss, paresthesia, vomiting, papilledema, and signs of hormonal imbalance.

Head injury.Decorticate posture may be among the variable features of a head injury, depending on the site and severity of the injury. Associated signs and symptoms include a headache, nausea and vomiting, dizziness, irritability, a decreased LOC, aphasia, hemiparesis, unilateral numbness, seizures, and pupillary dilation.

Stroke.Typically, a stroke involving the cerebral cortex produces unilateral decorticate posture, also called spastic hemiplegia. Other signs and symptoms include hemiplegia (contralateral to the lesion), dysarthria, dysphagia, unilateral sensory loss, apraxia, agnosia, aphasia, memory loss, a decreased LOC, urine retention, urinary incontinence, and constipation. Ocular effects include homonymous hemianopsia, diplopia, and blurred vision.

Nursing considerations

▪ Assess the patient frequently to detect subtle signs of neurologic deterioration.

▪ Monitor his neurologic status and vital signs every 30 minutes to 2 hours.

▪ Be alert for signs of increased ICP, including bradycardia, an increasing systolic blood pressure, and a widening pulse pressure.

Patient teaching

▪ Explain the signs and symptoms of decreased LOC and seizures to the patient and his family.

▪ Discuss the patient's and family's quality-of-life concerns.

▪ Explain to the family how to keep the patient safe, especially during a seizure.

▪ Explain to the patient or family his diagnosis and the treatment plan.

Book Source Details

• Book Title: Nursing: Interpreting Signs and Symptoms
• Author(s): Springhouse
• Year of Publication: 2007
• Copyright Details: Nursing: Interpreting Signs and Symptoms, Copyright © 2007 Lippincott Williams & Wilkins.

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Copyright notice for book excerpts: Copyright © 2008 Lippincott Williams & Wilkins. All rights reserved.

More About This Book: Title: Nursing: Interpreting Signs and Symptoms Authors: Springhouse Publisher: Lippincott Williams & Wilkins Copyright: 2007 ISBN: 1-58255-668-7

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