-
Journal of Neurophysiology Mar 1947
Topics: Decerebrate State; Humans
PubMed: 20291835
DOI: 10.1152/jn.1947.10.2.89 -
Journal of Neurosurgery Jan 1955
Topics: Adolescent; Brain; Brain Diseases; Child; Decerebrate State; Humans; Nervous System Diseases
PubMed: 13233978
DOI: 10.3171/jns.1955.12.1.0013 -
Neurologic Clinics Nov 2011Kinnier Wilson coined the term metabolic encephalopathy to describe a clinical state of global cerebral dysfunction induced by systemic stress that can vary in clinical... (Review)
Review
Kinnier Wilson coined the term metabolic encephalopathy to describe a clinical state of global cerebral dysfunction induced by systemic stress that can vary in clinical presentation from mild executive dysfunction to deep coma with decerebrate posturing; the causes are numerous. Some mechanisms by which cerebral dysfunction occurs in metabolic encephalopathies include focal or global cerebral edema, alterations in transmitter function, the accumulation of uncleared toxic metabolites, postcapillary venule vasogenic edema, and energy failure. This article focuses on common causes of metabolic encephalopathy, and reviews common causes, clinical presentations and, where relevant, management.
Topics: Brain Diseases, Metabolic; Consciousness Disorders; Decerebrate State; Electroencephalography; Evoked Potentials; Humans; Neuroimaging
PubMed: 22032664
DOI: 10.1016/j.ncl.2011.08.002 -
Journal of Intensive Care Medicine Oct 2016Criteria for establishing brain death (BD) require absence of all brainstem-mediated reflexes including motor (ie, decerebrate or decorticate) posturing. A number of... (Review)
Review
INTRODUCTION
Criteria for establishing brain death (BD) require absence of all brainstem-mediated reflexes including motor (ie, decerebrate or decorticate) posturing. A number of spinal cord automatisms may emerge after BD, but occurrence of decerebrate-like spinal reflexes may be particularly problematic; confusion of such stereotypic extension-pronation movements with brain stem reflexes may confound or delay definitive diagnosis of BD. We present a case in which we verified the noncerebral (ie, likely spinal) origin of such decerebrate-like reflexes.
METHODS
Case report and systematic review of literature.
RESULTS
A 63-year-old woman presented with large pontine hemorrhage and complete loss of cerebral function, including no motor response to pain. Apnea testing confirmed death by neurologic criteria. Thirty-six hours after BD declaration, during assessment for organ donation, she began to exhibit spontaneous and stimulus-induced stereotypic extension-pronation of the upper extremities. The similarity of these movements to decerebrate posturing prompted concern for retained brain stem function, but repeat neurological examination of cranial nerves and apnea testing did not reveal any cerebral responses. Electrocerebral silence on electroencephalogram and absent perfusion on nuclear medicine brain imaging further confirmed BD. Review of PubMed yielded 5 additional case reports and 4 cohorts describing cases of decerebrate-like extension-pronation movements presenting in a delayed fashion after BD.
CONCLUSION
Extension-pronation movements that mimic decerebrate posturing may be seen in a delayed fashion after BD. Verification of lack of any brain activity (by both examination and multiple ancillary tests) in this case and others prompts us to attribute these movements as spinal cord reflexes and propose they be recognized within the rubric of accepted post-BD automatisms that should not delay diagnosis or necessitate confirmatory testing.
Topics: Brain Death; Brain Stem; Decerebrate State; Electroencephalography; Female; Humans; Middle Aged; Muscle Contraction; Neurologic Examination; Spinal Nerves; Tissue and Organ Procurement
PubMed: 27170657
DOI: 10.1177/0885066616646076 -
Archives of Neurology Dec 1971
Topics: Adult; Arm; Brain Stem; Decerebrate State; Electromyography; Female; Hemiplegia; Humans; Middle Aged; Motion Pictures; Motor Activity; Motor Neurons; Muscle Contraction; Muscle Tonus; Muscles; Neck; Posture; Reflex; Terminology as Topic
PubMed: 5115553
DOI: 10.1001/archneur.1971.00490060051005 -
Archives of Neurology Dec 1971
Topics: Animals; Brain Stem; Decerebrate State; Electromyography; Haplorhini; Macaca; Muscle Contraction; Muscle Spasticity; Muscle Tonus; Muscles; Posture; Reflex; Reflex, Stretch
PubMed: 5000501
DOI: 10.1001/archneur.1971.00490060035004 -
Neurosurgery May 1982Decerebrate rigidity (DR) in humans results from a midbrain lesion and is manifested by an exaggerated extensor posture of all extremities. It is characterized by...
Decerebrate rigidity (DR) in humans results from a midbrain lesion and is manifested by an exaggerated extensor posture of all extremities. It is characterized by shortening and lengthening reactions and can be modified by tonic neck, labyrinthine (Magnus-de Kleijn), and phasic spinal reflexes. These criteria, and not extensor posture alone, reflect the observations of Sherrington and should form the basis of the clinical examination; however, the experimental-anatomical lesion and physiological findings can never be reproduced exactly in humans. "Tonic and cerebellar fits" are not the equivalent of DR, but are forms of muscle spasm that result in an extensor attitude. They are caused by irritation and excitation of the brain stem. The most common cause of DR in humans is trauma. The incidence of DR in head-injured patients may be as high as 40%, resulting in an average mortality rate of 80%; the presence of an extensor posture increases the mortality from 20 to 70%. The surgical removal of an intracranial lesion does not improve the high mortality rate in patients with craniocerebral trauma who are decerebrate. Although the Glasgow coma scale (GCS) does not consider the specific type of central nervous system abnormality caused by trauma, it is an accurate and accepted assessment of outcome after coma lasting longer than 6 hours. DR is a factor in the best motor response of the GCS and should be assigned major importance in the prognosis of comatose head-injured patients.
Topics: Brain Injuries; Brain Stem; Decerebrate State; Humans; Mesencephalon; Muscle Rigidity; Posture; Prognosis
PubMed: 7099417
DOI: 10.1227/00006123-198205000-00017 -
Neurology May 1972
Topics: Alcoholism; Blood Transfusion; Cephalothin; Decerebrate State; Diet Therapy; Glucose; Hepatic Encephalopathy; Humans; Liver Cirrhosis; Male; Mannitol; Middle Aged; Movement Disorders; Neomycin
PubMed: 4673451
DOI: 10.1212/wnl.22.5.537 -
JAMA Aug 1968
Topics: Aerospace Medicine; Decerebrate State; Humans; Whiplash Injuries
PubMed: 5695109
DOI: No ID Found -
Progress in Neurobiology 1987For the past 10 years, our group has been engaged in the study of posture and locomotion in decerebrate cats and in freely moving awake cats. Our initial objective was... (Review)
Review
For the past 10 years, our group has been engaged in the study of posture and locomotion in decerebrate cats and in freely moving awake cats. Our initial objective was to analyse the neuronal mechanisms of locomotion from a viewpoint of "postural control". Therefore, in this review, I have focussed my attention on two major control aspects of the brain stem; one related to the interaction of posture and locomotion; and the other to initiation of locomotion. It is apparent that elucidation of the second aspect is feasible. In Fig. 15, I have summarized all the neuronal structures that have been functionally identified as being actively involved in the regulation of posture and locomotion. Obviously, contribution of the cerebello-cerebral pathways and the basal ganglia to both the postural and to the locomotor control cannot be elucidated in decerebrate preparations (Fig. 15A). These contributions can, to a certain degree, be elucidated in intact awake cats (Fig. 15B). Although it is difficult to directly compare the results obtained in the decerebrate cats with those obtained in intact cats, it has been encouraging that the selective activation of certain neuronal structures within the brain stem allowed us to evoke comparable postural and locomotor changes in both groups of preparations. It can be expected that the knowledge obtained from studies of the cerebello-cerebral pathways and of the basal ganglia, together with those that can be further obtained from studies of the brain stem, should result in the elucidation of the two major control aspects of the brain stem described above. In this sense, both the models of the decerebrate locomotor preparation and the freely moving, awake cat seem to provide an unique opportunity to study the nature and the sources of command signals that set the postural and the locomotor synergies into a single functional synergy, and even to approach elucidation of the intriguing question as to how and where volitional control signals for initiating and/or halting locomotion are organized. More than 70 years have passed since the pioneer studies by Sherrington (1906) and by Graham Brown (1911, 1914) on postural control and on locomotion, as exemplified by "decerebrate reflex standing, and stepping" and the "central rhythmic generator" relating to locomotion. Based on these discoveries, Shik, Severin and Orlovsky (1966) have made a splendid breakthrough in a wide area of investigation relating to locomotion.(ABSTRACT TRUNCATED AT 400 WORDS)
Topics: Animals; Cats; Central Nervous System; Decerebrate State; Dogs; Locomotion; Posture
PubMed: 3544055
DOI: 10.1016/0301-0082(87)90010-4