Decorticate posture [Decorticate rigidity, abnormal flexor response]

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, page 103.)

Act Now: Obtain vital signs and evaluate the patient’s 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 intubation and mechanical ventilation, if necessary. Also, institute seizure precautions.

Assessment

History

Obtain a history from the patient (if possible) or his family. Did the patient complain about headache, dizziness, nausea, changes in vision, and numbness or tingling? When did he first notice these symptoms? Did the family observe any behavioral changes?

Ask about a history of cerebrovascular disease, cancer, meningitis, encephalitis, upper respiratory tract infection, bleeding or clotting disorders, or recent trauma.

Physical examination

Test the patient’s motor and sensory functions. Evaluate pupil size, equality, and response to light. Test cranial nerve function and deep tendon reflexes. Perform a complete neurologic examination and continue to perform frequent neurologic checks. Assess the patient’s respiratory function.

ALERT: Abnormal respirations may indicate a breakdown in the brain’s respiratory center and an impending tentorial herniation — a neurologic emergency.

Pediatric pointers

Decorticate posture is an unreliable sign before age 2 because of nervous system immaturity. Head injury and Reye’s syndrome can, however, cause decorticate posture in children.

Medical causes

Brain abscess.

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

Brain tumor

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 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 head injury. Associated signs and symptoms include headache, nausea and vomiting, dizziness, irritability, 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, decreased LOC, urine retention, urinary incontinence, and constipation. Ocular effects include homonymous hemianopsia, diplopia, and blurred vision.

Nursing considerations

Monitor neurologic status and vital signs every 30 minutes to 2 hours. Be alert for signs of increased ICP, including bradycardia, increasing systolic blood pressure, and widening pulse pressure.

Patient teaching

Instruct the patient and his family about the signs and symptoms of decreased LOC and seizures. Explain to the family or caregiver how to keep the patient safe, especially during a seizure. Discuss quality of life concerns, if appropriate. Provide referrals to other health care services and professionals, as indicated.

Copyright Details: Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series, Copyright © 2007 Lippincott Williams & Wilkins.

Other Book Chapters Related to Posture symptoms

Read the full text of these other book chapters:

Copyright Details: Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series, Copyright © 2008 Williams & Wilkins.

More About Causes of Posture symptoms

• Back to symptom: Posture symptoms: Introduction (review 61 causes)
• Next Book Extract About Posture symptoms: Decorticate posture (Signs & Symptoms: A 2-in-1 Reference for Nurses)
• All Book Extracts: All Online Book Extracts for Posture symptoms

---

More About This Book: Title: Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series Authors: Springhouse Publisher: Lippincott Williams & Wilkins Copyright: 2007 ISBN: 1-58255-624-5

Enter your search terms Submit search form
Search The Web Search wrongdiagnosis.com