Decorticate and decerebrate posturing can mimic tonic seizures. Decorticate posturing refers to flexor posturing of the upper extremities and extensor posturing of the lower extremities. In decerebrate posturing, both the upper and lower extremities show extensor stiffening. Both events can occur suddenly from a severe brain injury affecting the brainstem level. This posturing can be seen bilaterally or unilaterally in different herniation syndromes. Possible impending herniation should be considered in a comatose patient exhibiting sudden tonic stiffening (25).
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