Decorticate, decerebrate and opisthotonic posturing and seizures in Kenyan children with cerebral malaria

Table 3 Herniation syndromes and posturing

Herniation syndromes	Posturing (n = 163)	No posturing (n = 254)	P Value
Uncal¹	2 (1.2)	2 (0.8)	0.64
Diencephalic²	8 (4.9)	2 (0.8)	0.02
Midbrain/upper pontine³	0 (0.0)	2 (0.8)	0.52
Lower pontine⁴	2 (1.2)	1 (0.4)	0.56
Medullary⁵	19 (11.7)	12 (4.7)	0.01

¹ Unilateral mydriasis and unilateral fixed pupil, unilateral ptosis, minimal or no oculocephalic eye deviation and hemiparesis
² Cheynes-Stokes respiration, small or midpoint pupils reactive to light, full deviation of oculocephalic response, flexor response to pain and/or decorticate posturing, hypertonia and or hypereflexia with extensor planters
³ Hyperventilation, midpoint pupils fixed to light, minimal oculocephalic deviation, extensor response to pain or decerebrate posturing
⁴ Shallow or ataxic respiration, midpoint pupils fixed to light, no oculocephalic response, flexion of legs only, no response to pain or decorticate posturing, flaccid with extensor planters
⁵ Slow irregular or gasping respirations, dilated pupils fixed to light, respiratory arrest with adequate cardiac output