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Decorticate vs decerebrate posturing
Decorticate posturing is flexion: the arms bend in toward the chest with the legs extended, and it points to damage higher in the brain, above the red nucleus of the midbrain. Decerebrate posturing is extension: the arms and legs stretch out stiffly with the arms turned inward, it points to brainstem damage and it is the more serious sign.
Side by side
| Decorticate | Decerebrate | |
|---|---|---|
| Arms | Flexed, pulled in toward the chest, fists clenched | Extended straight at the sides, turned inward (pronated) |
| Legs | Extended and turned inward, toes pointed | Extended, toes pointed |
| Where the damage is | Above the red nucleus in the upper midbrain (cerebral cortex, internal capsule, thalamus) | The brainstem (midbrain, pons) |
| GCS motor score | 3 (abnormal flexion) | 2 (extension) |
| Seriousness | Serious | More serious, worse outlook |
Memory tricks
- DeCORticate: the arms pull in to the "core" (the chest).
- DecErebrate: the arms are Extended.
- Moving from decorticate to decerebrate posturing means the injury is getting worse.
What the nurse does
- Treat new posturing as an emergency and notify the provider right away.
- Protect the airway and breathing.
- Check the GCS, pupils and vital signs, and watch for Cushing's triad (high systolic pressure with a widening pulse pressure, slow heart rate, irregular breathing).
- Keep the head of the bed raised about 30 degrees with the head midline, unless ordered otherwise, to help venous drainage from the brain.
NCLEX tip: Any posturing on the NCLEX means a serious brain injury, often with rising intracranial pressure. Decerebrate is worse than decorticate, and a change from one to the other is a worsening sign to report.
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Frequently asked questions
Which is worse, decorticate or decerebrate?
Decerebrate posturing is worse because it points to damage in the brainstem.
What does decorticate posturing look like?
Arms flexed in toward the chest with clenched fists, legs extended and feet turned inward.
What GCS motor score is decerebrate posturing?
A motor score of 2 (extension). Decorticate posturing is a motor score of 3 (abnormal flexion).
Which is more serious, decorticate or decerebrate?
Decerebrate posturing is more serious. It points to damage in the brainstem, while decorticate posturing points to damage higher in the brain. A change from decorticate to decerebrate means the injury is getting worse and needs immediate action.
Keep studying
Sources
- Decerebrate and Decorticate Posturing, StatPearls, NCBI Bookshelf
- Glasgow Coma Scale, StatPearls, NCBI Bookshelf
For study only, not medical advice. Ranges and protocols vary by facility; follow your program, your facility's policies and the provider's orders.