Decorticate posture is an abnormal posturing that involves rigidity, flexion of the arms, clenched fists, and extended legs (held out straight). The arms are bent inward toward the body with the wrists and fingers bent and held on the chest.

This type of posturing is a sign of severe damage to the brain. It requires immediate medical attention.

Decorticate posture indicates damage to the corticospinal tract, the pathway between the brain and spinal cord. Although a serious sign, it is usually more favorable than decerebrate posture.

Decorticate posture may progress to decerebrate posture, or the two may alternate. The posturing may occur on one or both sides of the body.

• Stroke
• Bleeding in the brain (intracranial hemorrhage)
• Primary brain tumor
• Secondary brain tumor
• Encephalopathy
• Head injury
• Increased intracranial pressure from any cause
• Brain stem tumor
• Liver-induced brain dysfunction (hepatic encephalopathy)

Conditions associated with decorticate posture require immediate hospital treatment.

Abnormal posturing of any sort is usually associated with reduced level of consciousness (alertness). Anyone who has an abnormal posture should be examined promptly by a health care provider.

If associated with prolonged coma (unconsciousness), these behaviors can persist for an extended period of time.

Emergency measures may begin immediately, including placement of an artificial airway (breathing tube) and assistance with breathing. The person will likely be admitted to the hospital and placed in intensive care.

After the condition is stabilized, the medical history will be obtained from family members and a more extensive physical examination will be done. The physical exam will include a detailed assessment of the nervous system.

Medical history questions may include:

• When did this behavior start?
• Is there a pattern to the occurrences?
• Is it always the same type of posture?
• Is there any significant medical history (such as a known head injury or drug use)?
• What other symptoms came before or alone 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 chemical and minerals
• Head MRI or CT scan
• Cerebral angiography
• EEG
• ICP monitoring

The outlook depends on the cause of the posturing. Neurologic injury and brain damage may often result, leaving the person with persistent neurological deficits such as coma, inability to communicate, paralysis, or seizures.

Mayer SA. Head injury. In: Rowland LP, ed. Merritt’s Neurology. 11th ed. Baltimore, Md: Lippincott Williams & Wilkins; 2005:chap 64.