A systematic review and meta-analysis on abnormal posturing among brain injury patients

Wei, Yuyu; Cui, Yan; Pang, Xiaojun; Wang, Weijie

doi:10.1055/s-0044-1785689

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View and Review • Arq. Neuro-Psiquiatr. 82 (4) • 2024 • https://doi.org/10.1055/s-0044-1785689 copy

A systematic review and meta-analysis on abnormal posturing among brain injury patients

Uma revisão sistemática e metanálise sobre postura anormal entre pacientes com lesão cerebral

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Background

Abnormal motor posturing (AMP), exhibiting as decorticate, decerebrate, or opisthotonos, is regularly noticed among children and adults.

Objective

This systematic review and meta-analysis examined the risk factors and outcome of posturing among severe head and brain injury subjects.

Methods

Based on the inclusion and exclusion criteria and using MeSH terms: "decerebrate posturing", "opisthotonic posturing", "brain injury", and/or "cerebral injury" articles were searched on Scopus, PubMed, Science Direct, and google scholar databases. Observational studies, case series, and case reports were included.

Results

A total of 1953 studies were retrieved initially, and based on the selection criteria, 20 studies were finally selected for review and were analyzed for meta-analysis based on the mortality between the hematomas. The functional outcomes of this study are the risk factors, mortality rate and Glasgow Outcome Scale. Decerebrative patients were higher among the studies related to head injury surgeries. Males were mainly treated for decerebrate postures compared with the female subjects. Extradural hematoma and acute subdural hematoma with cerebral contusion were quite common in the surgical mass lesions.

Conclusion

The findings reported that the lesion types, the operative procedures, and the age of the decerebrating patients with brain injuries are the significant prognostic factors determining the survival outcomes.

Keywords
Decerebrate State; Brain Injuries; Systematic Review

No	Author, Year, Reference	Region	Sample size	Gender	Study	Age	Case subjects	Mortality Rate	Glasgow Outcome Scale (GOS)	Glasgow Coma Scale (GCS)
1.	Scarcella, 1962 ¹⁴14 Scarcella G, Fields WS. Recovery from coma and decerebrate rigidity of young patients following head injury. Acta Neurochir (Wien) 1962;10(02):134–144	USA	6	Case1= M Case2= M Case3= M Case4= F Case5= F Case6= M	CS	Case1= 5 Case2= 20 Case3= 5 Case4= 3 Case5= 18 Case6= 17	Decerebrate Rigidity in head injury	No deaths	NA	NA
2.	Celesia, 1963 ¹⁵15 Celesia GG, Andermann F. Some observations on the electro-graphic correlates of the decerebrate attack. Electroencephalogr Clin Neurophysiol 1964;16(03):295–300	Canada	1	Female	CR	10	Decerebrate attack in anoxic brain injury	No deaths	NA	NA
3.	Chatrian 1963 ¹⁶16 Chatrian GE, White LE Jr, Shaw CM. EEG pattern resembling wakefulness in unresponsive decerebrate state following traumatic brain-stem infarct. Electroencephalogr Clin Neurophysiol 1964;16(03):285–289	USA	1	Male	CR	59	Unresponsive decerebrate state in traumatic brain-stem infarct	Expired in respiratory and cardiac collapse after 14 days after the injury.	NA	NA
4.	Brendler, 1970 ¹⁷17 Brendler SJ, Selverstone B. Recovery from decerebration. Brain 1970;93(02):381–392	USA	16	M = 5, F = 4	Retrospective Study	Range = 14-67	Decerebrate rigidity in midbrain syndrome	Number of patients died: compressive lesions = 4, non-compressive lesions = 0	NA	NA
5.	Paul 1970 ¹⁸18 Gutterman P, Shenkin HA. Prognostic features in recovery from traumatic decerebration. J Neurosurg 1970;32(03):330–335	USA	52	M = 42 F = 10	Cross-sectional study	Mean = 30 range = 3-84	Decerebrate rigidity secondary to cranial trauma	Effect of surgical evacuation of intracranial hematoma on recovery from decerebration died: EDH = 3 (16-52 years age), SDH = 9(15-84 years age), ICH = 3(51-65 years age)	NA	NA
6.	North-Coombes 1972 ¹⁹19 North-Coombes N, Seedat YK, McKechnie JK. Decerebrate rigidity due to subdural haematoma. S Afr Med J 1972;46(40):1482–1483	South Africa	2	Case1: M Case2: M	CR	Case1: 50 Case2: 48	Decerebrate rigidity in subdural haematoma.	Case1: patient died	NA	NA
7.	Bricolo, 1977 ²⁰20 Bricolo A, Turazzi S, Alexandre A, Rizzuto N. Decerebrate rigidity in acute head injury. J Neurosurg 1977;47(05):680–689	Italy	800	NA	Compre- hensive Study	DP = 3 months to 86 years Non-DP-36	Decerebrate rigidity in acute head injury caused by traffic accidents	Motor signs outcome: decerebrate rigidity = (case No. 317; deaths No. 228 Full = (case No. 109; deaths No. 92	NA	NA
8.	Dong Hyun, 1977 ²¹21 Dong H, Suk HH. Clinical Evaluation of Traumatic Decerebration. J Korean Neurosurg Soc 1977;6(01):47–54	South Korea	42	M = 33 F = 9	Cross-sectional study	10-70 years old	Decerebrate rigidity in head injury	Decerebrate patients 65% with direct damage to the brain stem supratentorial hematoma 52%	NA	NA
9.	Davis, 1983 ²²22 Davis RA. Traumatic decerebrate rigidity and neurological recovery: a case report. Neurosurgery 1983;6(1):569–571	USA	1	F	CR	28	Traumatic Decerebrate Rigidity in head injury	No deaths	NA	GCS = 4 on initial examination
10.	Klug, 1984 ²³23 Klug N, Hoffmann O, Zierski J, Buss K, Laun A, Agnoli AL. Decerebrate rigidity and vegetative signs in the acute midbrain syndrome with special regard to motor activity and intracranial pressure. Acta Neurochir (Wien) 1984;72(3-4):219–233	Germany	25	NA	Cross-sectional study	Mean(SD) = 35 range = 11-68	Severe head injury (15) and Acute vascular brain lesions (10)	NA	NA	Frequency of DR Episodes in Relation GCS, Cisternal Obstruction
11.	Pattisapu 1985 ²⁴24 Pattisapu J, Smith RR, Bebin J. Traumatic decerebracy with preserved consciousness and voluntary movement. Neurosurgery 1985;16(01):71–74	USA	1	M	CR	32	Unilateral brain stem lesion in a patient with traumatic decerebracy	Patient died	NA	NA
12.	Jabre, 1985 ²⁵25 Jabre A, Sawaya R, Arthur S. Decerebrate posturing with the syndrome of inappropriate secretion of antidiuretic hormone. Surg Neurol 1985;23(01):56–58	USA	1	Male	CR	20	Decerebrate posturing in head injury	No deaths	NA	NA
13.	Mahapatra, 1985 ²⁶26 Mahapatra AK, Tandon PN, Bhatia R, Banerji AK. Bilateral decerebration in head-injury patients. An analysis of sixty-two cases. Surg Neurol 1985;23(05):536–540	India	62	M = 52 F = 10	Retrospective study	Mean(SD) = 28.5(2.3) range = 2-73	Head-injured patients with bilateral decerebration	Neurological manifestation outcome: Pinpoint, non-reacting pupils= 2 died vestibuloocular reflex outcome: 8 patients with absent reflex died	NA	GCS = 4 on initial examination
14.	Briggs 1986 ²⁷27 Briggs TB, Smith RR. Exertional rhabdomyolysis associated with decerebrate posturing. Neurosurgery 1986;19(02):297–299	USA	1	M	CR	42	Decerebrate posturing after a head injury led to rhabdomyolysis and renal failure.	Patient died	NA	NA
15.	Damasceno, 1991 ²⁸28 Damasceno BP. Decerebrate rigidity with preserved cognition and gait: a possible role of anoxic-ischemic brain damage. Int J Neurosci 1991;58(3-4):283–287	Brazil	1	Female	CR	27	Decerebrate rigidity with in anoxic-ischemic brain damage	No deaths	NA	NA
16.	Pranzatelli, 1991 ²⁹29 Pranzatelli MR, Pavlakis SG, Gould RJ, De Vivo DC. Hypothalamicmidbrain dysregulation syndrome: hypertension, hyperthermia, hyperventilation, and decerebration. J Child Neurol 1991;6(02):115–122	USA	3	Case1: M Case2: M Case3: M	CS	Case1: 13 Case2: 7 Case3: 19	Decerebration with opisthotonus	No deaths	NA	NA
17.	Kiboi, 2009 ³⁰30 Kiboi JG, Muriithi IM. Vertex epidural haematoma manifesting with bilateral upper limb decerebrate posture: case report. East Afr Med J 2009;86(06):300–304	Kenya	1	M	CR	46	Vertex epidural haematoma	No deaths	NA	On admission, the patient was unconscious with a Glasgow coma scale of 7/15 (motor 4, eye 2, verbal 1).
18.	Jung, 2013 ³¹31 Jung W, Kwon S, Park S, et al. Electroacupuncture for decorticate rigidity of the upper limbs in a patient with anoxic brain damage. Case Rep Med 2013;2013:524603	South Korea	1	M	CR	51	Decerebrate Rigidity in anoxic brain damage	No deaths	NA	At admission, he revealed GCS score 7 (E4 V0 M3)
19.	Woischneck,2014 ³²32 Bindal A, Chandra N, Ojha BK, Chandra A, Singh SK, Srivastava C. Outcome of surgery for operable supratentorial mass lesions in patients presenting with decerebration following severe head injury: A retrospective analysis of factors affecting outcome. Asian J Neurosurg 2015;10(03):145–148	Germany	120	M = 82 F = 38	Prospective study	Median = 36, range = 2-86	Decerebrate posturing following traumatic brain injury	Decerebrate rigidity, no midbrain lesion = 19%; (b) without decerebrate rigidity, with midbrain lesion = 41%; (c) with decerebrate rigidity and with midbrain lesion = 33%; (d) with decerebrate rigidity, no midbrain lesion = 21%	Patients with a decerebrate response revealed significantly lower GOS scores than those without (p= 0.01). Detection of a brainstem lesion on MRI was correlated to the GOS (p < 0.0001). The correlation of midbrain lesions with the GOS was also significant (p < 0.0001).	NA
20.	Amit, 2015 ³³33 Sterne JA, Hernán MA, Reeves BC, et al. ROBINS-I: a tool for assessing risk of bias in non-randomised studies of interventions. BMJ 2016;355:i4919	India	72	M =57 F = 15	Retrospective study	>60 years old	Operated patients with decerebrate rigidity secondary cranial trauma	60 (83%) is the total mortality rate in the series.	Favorable outcome (GOS 4 and 5) in 14% (n = 10) of the patients	GCS 4 (M2) at the time of operation

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[1] Address for correspondence Weijie Wang (email: wangweijie1477@outlook.com)