Decorticate posture is a sign of damage to the nerve pathway in the midbrain, which is between the brain and spinal cord. The midbrain controls 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 of decorticate posture include:

• Bleeding in the brain from any cause
• Brain stem tumor
• Stroke
• Brain problem due to 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
• Reye syndrome (sudden brain damage and liver function problems that affects children)
• Brain injury from lack of oxygen

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 and treated right away in a hospital.

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, the provider will get a medical history from family members or friends and a more detailed physical examination will be done. This will include a careful examination 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 posture always the same?
• Is there any history of a head injury or drug use?
• 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 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:

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

Abnormal posturing - decorticate posture; Traumatic brain injury - decorticate posture

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.

Bostwick TL. Altered mental status and coma. In: Bakes KM, Buchanan JA, Moreira ME, Byyny R, Pons PT, eds. Emergency Medicine Secrets. 7th ed. Philadelphia, PA: Elsevier; 2022:chap 14.

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.

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.

Updated by: Joseph V. Campellone, MD, Department of Neurology, Cooper Medical School of Rowan University, Camden, NJ. Review provided by VeriMed Healthcare Network. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.