Decorticate flexion or posturing is a neurological emergency that requires prompt diagnosis and treatment. It is typically an indication of a lesion in the frontal lobes, internal capsules, or cerebral peduncles. This can be secondary to an acute process such as traumatic brain injury (TBI) or stroke.
Clinically, it is marked by the patient’s arms being adducted (i.e., arms next to the body) with the wrists and fingers flexed on the chest. The legs are typically rigid and extended with internal rotation and the feet are in plantar flexion (i.e., toes are pointed.)
Because there is uncal herniation of the brain, the ipsilateral pupil is fixed and dilated (aka the pupil is “blown.”)