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Ambiguous paroxysmal events: posturing

This patient in the intensive care unit developed decorticate response. The patient developed clenched fist and arms flexion. There is loss of corticospinal tract function with intact rubrospinal fibers that receive excitatory projections from cerebellum. Posturing can be produced by hemispheric dysfunction or lesion at the brainstem just restoral to the superior colliculus. (Contributed by Dr. Selim R Benbadis.)