06/12/2025
⭐ Posturing in Brain Injury: Decorticate vs Decerebrate
The image shows two abnormal body postures that appear in severe brain injury. These postures help identify where the brain lesion is located.
🔵 1. Decorticate Posturing (Abnormal Flexion)
How it looks:
• Arms flexed inward over the chest
• Hands clenched
• Legs extended and stiff
What it means:
• Damage is above the brainstem, usually in the:
• Cerebral hemispheres
• Internal capsule
Why it happens:
The brain injury interrupts pathways from the cortex, so the flexor muscles overpower extensors → causing the patient to bring arms toward the “core” → “de-COR-ticate = toward the core.”
🔴 2. Decerebrate Posturing (Abnormal Extension)
How it looks:
• Arms extended straight down
• Hands turned outward
• Legs extended and stiff
• Body may arch
What it means:
• Damage is below the red nucleus, involving:
• Midbrain
• Brainstem
• Pons
Why it happens:
Lower brainstem injury removes flexor control → extensor muscles dominate → causing rigid extension of arms and legs.
⚠️ Clinical Severity
• Decorticate = severe injury
• Decerebrate = more severe and worse prognosis because the lesion is deeper in the brainstem.
