A patient who is unconscious exhibits internal rotation, adduction, and flexion of the arms when a painful stimulus is applied. This posturing is

• A. Decorticate posturing.
• B. Flexion withdrawal.
• C. Localization of pain.
• D. Decerebrate posturing.

Answer: (A)

This is decorticate posturing, an abnormal flexor posture seen with severe cerebral hemispheric injury. In response to pain, the arms become flexed with internal rotation and adduction, often drawn toward the body, reflecting disruption of corticospinal pathways above the red nucleus. This pattern indicates a high level of brain injury and is distinct from decerebrate posturing, where the limbs extend due to brainstem (midbrain/upper pons) involvement. Flexion withdrawal would be a quick, localized withdrawal from the stimulus rather than a fixed arm posture, and localization of pain would be purposeful movement toward the stimulus rather than a stereotyped posture.