TABLE 1616 Abnormal Postures in Comatose Patients

- Flexed

Plantar flexed

- Flexed

Internally rotated Flexed v Adducted

Externally rotated

Flaccid

Internally rotated Flexed v Adducted

Externally rotated

Flaccid

Decorticate Rigidity (Abnormal Flexor Response)

In decorticate rigidity, the upper arms are held tight to the sides with elbows, wrists, and fingers flexed. The legs are extended and internally rotated. The feet are plantar flexed. This posture implies a destructive lesion of the corticospinal tracts within or very near the cerebral hemispheres. When unilateral, this is the posture of chronic spastic hemiplegia.

Hemiplegia (Early)

Sudden unilateral brain damage involving the corticospinal tract may produce a hemiplegia (one-sided paralysis), which early in its course is flaccid. Spasticity will develop later. The paralyzed arm and leg are slack. They fall loosely and without tone when raised and dropped to the bed. Spontaneous movements or responses to noxious stimuli are limited to the opposite side. The leg may lie externally rotated. One side of the lower face may be paralyzed, and that cheek puffs out on expiration. Both eyes may be turned away from the paralyzed side.

Extended Adducted

Flexed

Extended Adducted

Flexed

Decerebrate Rigidity (Abnormal Extensor Response)

In decerebrate rigidity, the jaws are clenched and the neck is extended. The arms are adducted and stiffly extended at the elbows, with forearms pronated, wrists and fingers flexed. The legs are stiffly extended at the knees, with the feet plantar flexed. This posture may occur spontaneously or only in response to external stimuli such as light, noise, or pain. It is caused by a lesion in the diencephalon, midbrain, or pons, although severe metabolic disorders such as hypoxia or hypoglycemia may also produce it.

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