simultaneous decerebrate and decorticate posteuring

Lifeguards For Life

Lifeguards For Life

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What would cause a patient to display decerebrate posteuring on one side of the body AND decorticate posteuring on the other side of the body?
Is the answer as simple as some combination of upper brainstem injury mixed with bilateral corticospinal tract damage?
 
Lifeguards For Life said:
What would cause a patient to display decerebrate posteuring on one side of the body AND decorticate posteuring on the other side of the body?
Is the answer as simple as some combination of upper brainstem injury mixed with bilateral corticospinal tract damage?
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And, if a combination of upper brainstem injury mixed with bilateral corticospinal tract damage was the reason, why would the two postures be displayed simultaneously as opposed to alternating between decerebrate and decorticate as the neurologic status fluctuates?
...maybe should of posted this in the ALS or scenario section
 
Lifeguards For Life said:
What would cause a patient to display decerebrate posteuring on one side of the body AND decorticate posteuring on the other side of the body?
Is the answer as simple as some combination of upper brainstem injury mixed with bilateral corticospinal tract damage?
Click to expand...

Wide spread brain damage...
 
rescue99 said:
Wide spread brain damage...
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as opposed to displaying either one or the other? is that to say this is a relatively common finding, for a patient to display one type of posturing on one side and a different posturing contralateraly?
 
Lifeguards For Life said:
as opposed to displaying either one or the other? is that to say this is a relatively common finding, for a patient to display one type of posturing on one side and a different posturing contralateraly?
Click to expand...

Lets see if I can get this right. Decerbrate is a midbrain, cerebellum and / or stem injury while decorticate implies a motor neuron disfunction affecting the lateral corticospinal tract. Causes are many. Both can be present at the same time.
 
rescue99 said:
Lets see if I can get this right. Decerbrate is a midbrain, cerebellum and / or stem injury while decorticate implies a motor neuron disfunction affecting the lateral corticospinal tract. Causes are many. Both can be present at the same time.
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i think decerebrate is from injury to the upper brain stem, and decorticate results from trauma to one or both cortico spinal tracts. i was just unclear what would cause the two to happen simultaneuos and contralaterally as opposed to one and then the other alternating as the patients neruo status fluctuates, if that makes sense to you?
 
Both are for sure bad news. Decorticate is down further, but both should be a vegetative state, on ventilator etc.
 
Lifeguards For Life said:
i think decerebrate is from injury to the upper brain stem, and decorticate results from trauma to one or both cortico spinal tracts. i was just unclear what would cause the two to happen simultaneuos and contralaterally as opposed to one and then the other alternating as the patients neruo status fluctuates, if that makes sense to you?
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Oh man..I had tried to rethink my post but went over the time. Let me try this again.

The dysfunction is to both the corticospinal /rubrospinal tracts and implies brain stem injury (lower specifically I believe). There will always be other significant damage caused by either illness, hypoxia, injury or bleeds..right & left hemisphere, thalamus, mid brain perhaps. Check the pupils and note something unique ;)
 
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rescue99 said:
You are partly right. Anyone? Bueller, Bueller...

Man, my multi taksing skills stink tonight...go Tigers!
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accompanied with abnormal pupil size and innapropriate response to light? are we only talking about the eyes? if i have not answered right, i would like to know the correct answer:)
 
rhan101277 said:
Both are for sure bad news. Decorticate is down further, but both should be a vegetative state, on ventilator etc.
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decorticate generally offers a better prognosis and may progress into decerebrate if the causative disorder extends lower into the brainstem
 
Lifeguards For Life said:
accompanied with abnormal pupil size and innapropriate response to light? are we only talking about the eyes? if i have not answered right, i would like to know the correct answer:)
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LOL..you just said absence of dolls eyes! The pupils will dilate in and out at random.
 
rescue99 said:
Could I suppose. There are lots of folks alert with the type of brain damage you describe. Some have doll looking eyes, some not.
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Dolls eyes (lack of oculovestibular reflex) indicates bilateral pontine injury. It is seen when there is an absence of brainstem activity. Not something you'll see while the patient is chatting to you post head injury.
 
Having just read the whole post instead of the the last reply all I can say is: what?

Can someone please post the question lucidly, and be careful that you use the right terminology eg dolls eyes represents an absence of the oculovestibular reflex which would normally keep the eyes fixed at one point while the head moves. Therefore the dolls eye sign is fixed gaze even when the head is moved and is a very grave sign (see above). It is also very creepy.

However it is not correct to call it a reflex.

Inappropriate miosis/midriasis can result from a number of causes, such as seizures. Of course even in a paralysed (with medication) patient there will still be some fluctuation of pupil size due to fluctuations in intraocular pressure.

Anyway, what was the question again?
 
Let's see...

Thread is "posturing".
First cause: pt happened to assume that position. Rearrange them then see what they assume.
Second cause: misinterpretation.
Third cause: pt rapidly on the way out, cut the hairsplittnig and didimau.

Never heard of brainstem signs being unilateral. Hmmmmm.

Oh, consider likely cause of this, be it toxic, mechanical open, mechanical closed, mechanical delayed/closed, or vascular. or neoplastic. Or infectious. The zebras draw nearer, but etiology is good info for the ER your pt needs to get to.
 
Ok, got it. Got distracted by the errors concerning dolls eye sign. Alternating posturing on either side is not something I have heard of or seen. What was the scenario?
 
Smash said:
Ok, got it. Got distracted by the errors concerning dolls eye sign. Alternating posturing on either side is not something I have heard of or seen. What was the scenario?
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I agree, erroneous information on the doll's eyes, as well I really doubt the posturing was alternating unless they went to progressive posturing as in ICP causing more damage. In regards to doll's eyes many perform the easy caloric test to detect brain stem function test.

R/r 911
 
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