Abnormal posturing overview

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

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Overview

Abnormal posturing is an involuntary flexion or extension of the arms and legs, indicating severe brain injury. It occurs when one set of muscles becomes incapacitated while the opposing set is not, and an external stimulus such as pain causes the working set of muscles to contract.[1] The posturing may also occur without a stimulus.[2] Since posturing is an important indicator of the amount of damage that has occurred to the brain, it is used by medical professionals to measure the severity of a coma with the Glasgow Coma Scale (for adults) and the Pediatric Glasgow Coma Scale (for infants).

Classification

The two types of abnormal posturing are decorticate and decerebrate posturing. Opisthotonos, in which the head and back are arched backward, is another form of abnormal posturing.

Causes

Decerebrate and decorticate posturing can indicate that brain herniation is occurring[3] or is about to occur. Brain herniation is an extremely dangerous condition in which parts of the brain are pushed past hard structures within the skull. In herniation syndrome, which is indicative of brain herniation, decorticate posturing occurs, and, if the condition is left untreated, develops into decerebrate posturing.[3]

Natural History, Complications and Prognosis

The presence of posturing indicates a severe medical emergency requiring immediate medical attention. Decerebrate and decorticate posturing are strongly associated with poor outcome in a variety of conditions. For example, near-drowning victims that display decerebrate or decorticate posturing have worse outcomes than those that do not.[4] Changes in the condition of the patient may cause him or her to alternate between different types of posturing.[5]

References

  1. AllRefer.com. 2003 “Decorticate Posture”. Retrieved January 15, 2007.
  2. WrongDiagnosis.com, Decorticate posture: Decorticate rigidity, abnormal flexor response (Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series). Retrieved on September 15, 2007.
  3. 3.0 3.1 Ayling, J (2002). "Managing head injuries". Emergency Medical Services. 31 (8): 42. PMID 12224233. |access-date= requires |url= (help)
  4. Nagel, FO (1990). "Childhood near-drowning--factors associated with poor outcome". South African Medical Journal. 78 (7): 422–425. PMID 2218768. Unknown parameter |coauthors= ignored (help); |access-date= requires |url= (help)
  5. ADAM. Medical Encyclopedia: Abnormal posturing. Retrieved on September 3, 2007.

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