Fencing position refers to an abnormal posture that involves holding one arm flexed and adducted against the chest and extending the opposite leg. This position is a common response seen in strokes that affect the non-dominant side of the brain, leading to contralateral deficits. Understanding fencing position is important for recognizing and treating stroke. Let’s explore what causes this posture and what it signifies.
What Causes Fencing Position?
Fencing position occurs due to damage to the non-dominant hemisphere of the brain, which controls the dominant side of the body. For right-handed individuals, strokes affecting the left side of the brain often cause right-sided weakness or paralysis. This leads to the right arm contracting inward toward the chest in a flexed position, while the right leg extends out straight.
The exact region of the brain affected determines which deficits appear. Strokes in the frontal and parietal lobes often disrupt motor function, leading to contralateral paralysis. Meanwhile, strokes in the basal ganglia can cause abnormal posturing like fencing position due to their role in motor control.
Common Causes of Fencing Position
- Middle cerebral artery stroke – Impairs frontal, parietal, and temporal lobe function
- Anterior cerebral artery stroke – Affects the frontal and parietal lobes
- Lacunar stroke in the basal ganglia – Disrupts connections from this region to motor areas
- Intracranial hemorrhage – Bleeding causes pressure on motor areas
What Does Fencing Position Indicate?
The fencing posture is an important marker of contralateral motor deficits. The specific parts of the exam impacted can help localize the region affected by a stroke. Key indications include:
- Arm adduction and flexion – Reflects upper limb paresis due to damage to the frontal and parietal motor cortex or corticospinal tracts
- Leg extension – Indicates lower limb paresis from stroke impacting the parietal lobe or internal capsule
- Hemisensory loss – Diminished sensation on the affected side suggests parietal lobe involvement
- Aphasia – Speech deficits point to damage in the frontal and temporal language areas (left hemisphere)
Fencing position is often seen in large middle cerebral artery strokes and intracerebral hemorrhages affecting the dominant hemisphere. The presence of other stroke symptoms like facial drooping, speech difficulties, and gaze abnormalities helps confirm this diagnosis.
How is Fencing Position Treated?
As fencing position results from an underlying stroke, treatment focuses on stabilizing the patient and restoring blood flow to the brain. Critical interventions include:
- Airway/breathing support – Intubation or oxygen may be needed if stroke impacts brainstem function
- Blood pressure management – Careful BP control avoids hemorrhage expansion
- Intravenous fluids – Prevents dehydration and maintains circulation
- CT scan – Confirms stroke and distinguishes hemorrhage from infarct
- tPA – Thrombolytic clot-busting drug for eligible ischemic strokes
- Decompressive surgery – Removes part of the skull to accommodate swelling
- Aspiration precautions – Preventing food/fluid from entering lungs due to dysphagia
Once the patient is medically stable, rehabilitation focuses on regaining motor function through physical and occupational therapy. Spasticity medications may be trialed to relax hypertonicity contributing to abnormal postures.
What is the Prognosis with Fencing Position?
The prognosis for fencing position depends on the severity and location of the initial stroke. Small lacunar strokes confined to the basal ganglia have a better prognosis than large dominant hemispheric infarcts or hemorrhages. In general:
- Brainstem stroke – Very poor prognosis with high mortality
- Large MCA stroke – Moderate-poor prognosis, with significant permanent deficits
- Small lacunar stroke – Good prognosis with therapy to regain function
Even with rehabilitation, residual weakness, coordination problems, and spasticity often persist long-term. Patients may require assistance with activities of daily living. However, regaining some degree of independence is often possible with time and effort.
Key Takeaways
- Fencing position refers to abnormal posturing with one arm adducted and flexed, and the contralateral leg extended.
- It results from strokes damaging the non-dominant motor cortex and corticospinal tracts.
- Fencing response signifies a large MCA stroke or hemorrhage affecting the dominant hemisphere.
- Treatment focuses on stabilizing vitals, restoring blood flow, and preventing complications.
- Prognosis depends on stroke size and location; outcomes range from death to moderate disability.
Conclusion
In summary, fencing position is an important red flag signifying a major stroke affecting the dominant half of the brain. Its presence warrants rapid evaluation and management to minimize brain injury and restore neurologic function. While outcomes are variable, aggressive rehabilitation can help patients regain independence after fencing posture from stroke. Being aware of this characteristic posturing can assist with rapid stroke identification and treatment.