Decerebrate posturing with the syndrome of inappropriate secretion of antidiuretic hormone

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

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.

Completely reversible, severe, acute neurological deterioration with an otherwise asymptomatic, huge intradiploic calvarial epidermal cyst

A huge, intradiploic, right temporoparietal epidermal cyst was known to be present, unchanged in extent, for over 14 years in a 55-year-old man. Although extreme mass effect was demonstrated by computed tomography scans, results of the neurological examination were within normal limits. Treatment of nausea and vomiting after vestibular testing caused somnolence and an acute diencephalic-mesencephalic syndrome of tentorial herniation. However, only moderate amounts of analgesics and sedatives were given. These symptoms disappeared as the pharmacological sedative effect diminished. Thereafter the tumor was resected radically. Neuropathological examination confirmed an epidermal cyst. Results of the postoperative neurological examination were within normal limits.