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Strokes and Positioning

Posted

Specializes in Cath Lab, OR, CPHN/SN, ER.

Hi! I recently finished my second to last semester of nursing school, which included neuro. I had a question, and my instructor was unable to answer it. I'm not even sure if it's possible, but I'm curious to know. If someone has a severe stroke, would they exhibit positioning only on the opposite side? I know it depends on how severe the stroke is though. Thoughts? Thanks! -Andrea

Not sure what you mean by positioning on the opposite side? Do you mean weakness or paralysis? CVA's are all different. The amount of deficit the patient exhibits depends on the type of stroke i.e. ischemic or hemorrhagic and the area of the brain affected. The stroke patients in our rehab unit run the gammit from mild paraparesis to quadaplegia. Some have deficits on one side, some have deficits on the lower limbs, some have weakness in only one lower limb, some have no motor deficit, but exhibit severe dysphasia, etc. etc. They are all different.

Aneroo, LPN

Specializes in Cath Lab, OR, CPHN/SN, ER.

I meant decerebate and decorticate. Sorry. -Andrea

geekgolightly, BSN, RN

Specializes in MICU, neuro, orthotrauma. Has 7 years experience.

I meant decerebate and decorticate. Sorry. -Andrea

decerebrate is midbrain... so if the ischemic stroke affected the midbrain, decerebrate posturing would be seen, and it would most likely affect both sides of the body.

decorticate can be seen when the ischemic stroke affects the cerebral hemisphere just above the midbrain with the affected side being contralateral to the area of the stroke.

all hemorrhagic strokes can cause posturing if large enough.

i think all of this info is correct. please someone add if im wrong. still new to neuro nursing; only a year into it.

  • decerebrate posture indicates deterioration of the structures of the nervous system, particularly deterioration of the upper brain stem.

    decerebrate posture occurs in many patterns. it can occur on one side, on both sides, or in just the arms. it may alternate with decorticate posture, or a person can have decorticate posture on one side and decerebrate posture on the other.

  • decorticate posture indicates damage to the corticospinal tract (the pathway between the brain and spinal cord). although a serious sign, it is usually more favorable than decerebrate posture.

    decorticate posture may progress to decerebrate posture, or the two may alternate. the posturing may occur on one or both sides of the body.

check umms web site for more info...

http://www.umm.edu/ency/article/003300.htm

geekgolightly, BSN, RN

Specializes in MICU, neuro, orthotrauma. Has 7 years experience.

DECORTICATE REFLEX - Spontaneous flexion of the elbows with the legs extended. Accompanies severe damage to the contralateral cerebral hemisphere above the midbrain (e.g. stroke). The destruction of the cerebral cortex, usually due to anoxia, trauma, or toxic insult; may proceed to decerebration (a more severe neurologic state).

DECEREBRATION - Spontaneous extension of elbows, wrists, and legs which suggests damage to the diencephalon (midbrain). Seen in cases of stroke and some cases of encephalitis. The decerebrate reflex is a clinical finding characterized by rigid contraction of the extensor and other muscles which maintain an animal in the standing position (antigravity muscles); may be seen in association with a severe stroke, intracranial hemorrhage, cerebral hemorrhage, cerebral toxin, or transection of the brain below the level of the anterior corpora quadrigemina but above the vestibular nuclei; clinically may be preceded by decortication.

http://www.medhelp.org/glossary2/new/gls_1550.htm

Aneroo, LPN

Specializes in Cath Lab, OR, CPHN/SN, ER.

Thanks to all of you. I did not realize that the response could be so varied. -Andrea

Hi! I recently finished my second to last semester of nursing school, which included neuro. I had a question, and my instructor was unable to answer it. I'm not even sure if it's possible, but I'm curious to know. If someone has a severe stroke, would they exhibit positioning only on the opposite side? I know it depends on how severe the stroke is though. Thoughts? Thanks! -Andrea

If you mean which side is affected, you can have weakness on the same side as the bleed if there is herniation going down into the base of the skull (foramen magnum?). I had this explained to me by a neurologist. And for the most part, don't hesitate to ask them. They're usually pretty good about it.

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