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. 1973 Jun;36(3):431–444. doi: 10.1136/jnnp.36.3.431

Patterns of decerebration in infants and children: defects in homeostasis and sequelae

J K Brown 1,2,3, T T S Ingram 1,2,3, S S Seshia 1,2,3
PMCID: PMC494343  PMID: 4714105

Abstract

Sixty-four infants and children showing signs of decerebrate rigidity admitted to a paediatric unit have been studied. Cases of head injury, myelomeningocoele, and tumours were excluded from the series. The aetiological factors causing decerebration in the remainder fell into four main groups: infections, hypoxia, metabolic disease, and intracranial haemorrhage. Increased intracranial pressure was diagnosed in 87%. Defects in homeostasis occurred in 75%, respiratory abnormalities were present in 66%, cardiovascular in 33%, hypothermia in 30%, and hyponatraemia in 17%. Early recognition and treatment of raised intracranial pressure and defects in homeostasis are of the utmost importance if morbidity and mortality are to be minimized. There was a 31% mortality from the acute illness: 30% of the survivors were normal at follow-up examination; the remainder showed varying degrees of handicap. The severity of decerebration showed no correlation with aetiology or prognosis. The study shows that a wide range of disorders can lead to the clinical picture of decerebration in the young child, and that the prognosis is probably much better than in adults showing the same symptoms and signs.

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Brendler S. J., Selverstone B. Recovery from decerebration. Brain. 1970;93(2):381–392. doi: 10.1093/brain/93.2.381. [DOI] [PubMed] [Google Scholar]
  2. Brown J. K. Neurological and EEG findings in infants with disordered calcium and magnesium metabolism. Arch Dis Child. 1970 Apr;45(240):273–274. doi: 10.1136/adc.45.240.273-b. [DOI] [PMC free article] [PubMed] [Google Scholar]
  3. CHAPMAN W. P., LIVINGSTON R. B., LIVINGSTON K. E., SWEET W. H. Possible cortical areas involved in arterial hypertension. Res Publ Assoc Res Nerv Ment Dis. 1949 Dec;29:775–798. [PubMed] [Google Scholar]
  4. COOKE R. E., NYHAN W. L. Symptomatic hyponatremia in acute infections of the central nervous system. Pediatrics. 1956 Oct;18(4):604–613. [PubMed] [Google Scholar]
  5. Conomy J. P., Swash M. Reversible decerebrate and decorticate postures in hepatic coma. N Engl J Med. 1968 Apr 18;278(16):876–879. doi: 10.1056/NEJM196804182781603. [DOI] [PubMed] [Google Scholar]
  6. DENNY-BROWN D. THE PREMOTOR SYNDROME IN RELATION TO EXTRAPYRAMIDAL SYMPTOMS. Int J Neurol. 1963;4:21–38. [PubMed] [Google Scholar]
  7. DENNY-BROWN D. The midbrain and motor integration. Proc R Soc Med. 1962 Jul;55:527–538. doi: 10.1177/003591576205500701. [DOI] [PMC free article] [PubMed] [Google Scholar]
  8. Ducker T. B. Increased intracranial pressure and pulmonary edema. 1. Clinical study of 11 patients. J Neurosurg. 1968 Feb;28(2):112–117. doi: 10.3171/jns.1968.28.2.0112. [DOI] [PubMed] [Google Scholar]
  9. EMERY J. L., CAMPBELL REID D. A. Cerebral oedema and spastic hemiplegia following minor burns in young children. Br J Surg. 1962 Jul;50:53–56. doi: 10.1002/bjs.18005021914. [DOI] [PubMed] [Google Scholar]
  10. Gray O. P., Prosser R. Heart failure with brain damage in the newborn. Br Heart J. 1967 Jan;29(1):30–33. doi: 10.1136/hrt.29.1.30. [DOI] [PMC free article] [PubMed] [Google Scholar]
  11. Green M. Benign intracranial hypertension (pseudotumor cerebri). Pediatr Clin North Am. 1967 Nov;14(4):819–830. [PubMed] [Google Scholar]
  12. Gutterman P., Shenkin H. A. Prognostic features in recovery from traumatic decerebration. J Neurosurg. 1970 Mar;32(3):330–335. doi: 10.3171/jns.1970.32.3.0330. [DOI] [PubMed] [Google Scholar]
  13. Halsey J. H., Downie A. W. Decerebrate rigidity with preservation of consciousness. J Neurol Neurosurg Psychiatry. 1966 Aug;29(4):350–355. doi: 10.1136/jnnp.29.4.350. [DOI] [PMC free article] [PubMed] [Google Scholar]
  14. Hilton S. M. Hypothalamic regulation of the cardiovascular system. Br Med Bull. 1966 Sep;22(3):243–248. doi: 10.1093/oxfordjournals.bmb.a070481. [DOI] [PubMed] [Google Scholar]
  15. Ingram T. T., Stark G. D., Blackburn I. Ataxia and other neurological disorders as sequels of severe hypoglycaemia in childhood. Brain. 1967 Dec;90(4):851–862. doi: 10.1093/brain/90.4.851. [DOI] [PubMed] [Google Scholar]
  16. JOHNSON R. T., YATES P. O. Clinicopathological aspects of pressure changes at the tentorium. Acta radiol. 1956 Jul-Aug;46(1-2):242–249. doi: 10.3109/00016925609170833. [DOI] [PubMed] [Google Scholar]
  17. Levine R., Haft D. E. Carbohydrate homeostasis. N Engl J Med. 1970 Jul 30;283(5):237–246. doi: 10.1056/NEJM197007302830506. [DOI] [PubMed] [Google Scholar]
  18. MANGOS J. A., LOBECK C. C. STUDIES OF SUSTAINED HYPONATREMIA DUE TO CENTRAL NERVOUS SYSTEM INFECTION. Pediatrics. 1964 Oct;34:503–510. [PubMed] [Google Scholar]
  19. Martin J. K., Norman R. M. Maple syrup urine disease in an infant with microgyria. Dev Med Child Neurol. 1967 Apr;9(2):152–159. doi: 10.1111/j.1469-8749.1967.tb02236.x. [DOI] [PubMed] [Google Scholar]
  20. Morley A. R. Laryngeal stridor, Arnold-Chiari malformation and medullary haemorrhages. Dev Med Child Neurol. 1969 Aug;11(4):471–474. doi: 10.1111/j.1469-8749.1969.tb01466.x. [DOI] [PubMed] [Google Scholar]
  21. Morris-Jones P. H., Houston I. B., Evans R. C. Prognosis of the neurological complications of acute hypernatraemia. Lancet. 1967 Dec 30;2(7531):1385–1389. doi: 10.1016/s0140-6736(67)93022-x. [DOI] [PubMed] [Google Scholar]
  22. PAINE R., SMITH J. R., HOWARD F. A. Pulmonary edema in patients dying with disease of the central nervous system. J Am Med Assoc. 1952 Jun 14;149(7):643–646. doi: 10.1001/jama.1952.02930240021008. [DOI] [PubMed] [Google Scholar]
  23. PLUM F., SWANSON A. G. Central neurogenic hyperventilation in man. AMA Arch Neurol Psychiatry. 1959 May;81(5):535–549. doi: 10.1001/archneurpsyc.1959.02340170001001. [DOI] [PubMed] [Google Scholar]
  25. POSNER J. B., SWANSON A. G., PLUM F. ACID-BASE BALANCE IN CEREBROSPINAL FLUID. Arch Neurol. 1965 May;12:479–496. doi: 10.1001/archneur.1965.00460290035006. [DOI] [PubMed] [Google Scholar]
  26. REYE R. D., MORGAN G., BARAL J. ENCEPHALOPATHY AND FATTY DEGENERATION OF THE VISCERA. A DISEASE ENTITY IN CHILDHOOD. Lancet. 1963 Oct 12;2(7311):749–752. doi: 10.1016/s0140-6736(63)90554-3. [DOI] [PubMed] [Google Scholar]
  27. ROBERTSON R. C., POLLARD C., Jr Decerebrate state in children and adolescents. J Neurosurg. 1955 Jan;12(1):13–17. doi: 10.3171/jns.1955.12.1.0013. [DOI] [PubMed] [Google Scholar]
  28. RUSHWORTH G. THE NATURE AND MANAGEMENT OF SPASTICITY. THE PATHOPHYSIOLOGY OF SPASTICITY. Proc R Soc Med. 1964 Aug;57:715–720. doi: 10.1177/003591576405700821. [DOI] [PMC free article] [PubMed] [Google Scholar]
  29. Roddie I. C. Temperature control. Practitioner. 1969 Jul;202(213):108–114. [PubMed] [Google Scholar]
  30. SHUSTER S. The electrocardiogram in subarachnoid haemorrhage. Br Heart J. 1960 Jun;22:316–320. doi: 10.1136/hrt.22.3.316. [DOI] [PMC free article] [PubMed] [Google Scholar]
  31. Shenkin H. A., Bouzarth W. F. Clinical methods of reducing intracranial pressure. Role of the cerebral circulation. N Engl J Med. 1970 Jun 25;282(26):1465–1471. doi: 10.1056/NEJM197006252822606. [DOI] [PubMed] [Google Scholar]
  32. Sherrington C. S. Decerebrate Rigidity, and Reflex Coordination of Movements. J Physiol. 1898 Feb 17;22(4):319–332. doi: 10.1113/jphysiol.1898.sp000697. [DOI] [PMC free article] [PubMed] [Google Scholar]
  33. Simpson H. Encephalopathy and fatty degeneration of the viscera. Acid-base observations. Lancet. 1966 Dec 10;2(7476):1274–1277. doi: 10.1016/s0140-6736(66)91689-8. [DOI] [PubMed] [Google Scholar]
  34. Wilson J. Ataxia in childhood. Dev Med Child Neurol. 1968 Jun;10(3):388–390. doi: 10.1111/j.1469-8749.1968.tb02904.x. [DOI] [PubMed] [Google Scholar]
  35. Young E., Bradley R. F. Cerebral edema with irreversible coma in severe diabetic ketoacidosis. N Engl J Med. 1967 Mar 23;276(12):665–669. doi: 10.1056/NEJM196703232761204. [DOI] [PubMed] [Google Scholar]

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