From the Guidelines
Decerebrate posturing is associated with hemorrhages in the brainstem, particularly the midbrain and pons, while decorticate posturing is linked to damage in the cerebral cortex and its connections through the internal capsule, often caused by hemorrhages in the cerebral hemispheres or basal ganglia. When considering the locations in the brain for decerebrate and decorticate hemorrhage, it's crucial to understand the impact of hematoma location on survival and functional outcome, as highlighted in a 2020 study published in the journal Stroke 1. Key points to consider include:
- The site of intracerebral hemorrhage (ICH) has a significant impact on survival and functional outcome, with infratentorial location predicting a higher likelihood of death and being a current clinical indication for surgery in case of cerebellar ICH.
- Prognosis varies according to deep and lobar location of supratentorial ICH, with ICH involving the posterior limb of internal capsule or thalamus tends to have poorer outcomes compared to other locations. Given this information, it's essential to recognize that decerebrate posturing, which involves rigid extension of the arms and legs, with internal rotation of the arms and plantar flexion of the feet, is indicative of damage to the brainstem, which can occur from hemorrhages in the posterior fossa, brainstem, or severe transtentorial herniation. On the other hand, decorticate posturing, characterized by flexion of the arms, wrists, and fingers with extension of the legs, suggests damage to cortical areas but relative preservation of brainstem function, often caused by hemorrhages in the cerebral hemispheres or basal ganglia. These postures are critical clinical signs that aid in localizing brain injury and assessing its severity in neurological emergencies, emphasizing the need for prompt and accurate diagnosis to guide appropriate management and improve patient outcomes.
From the Research
Locations in the Brain for Decerebrate and Decorticate Hemorrhage
- Decerebrate posturing is associated with damage to the brainstem, specifically the midbrain and pons, as seen in primary brainstem hemorrhage (PBSH) 2.
- Decorticate posturing is associated with damage to the cerebral cortex, specifically the areas above the cerebellum, and can be caused by a variety of factors, including head injuries and hemorrhages in the basal ganglia, thalamus, and other areas 3, 4.
Key Areas of the Brain Involved
- Brainstem (midbrain and pons) for decerebrate posturing 2
- Cerebral cortex (areas above the cerebellum) for decorticate posturing 4
- Basal ganglia, thalamus, and other areas for decorticate posturing 3