[A 71-year-old man with Cushing reflex].
BACKGROUND
The Cushing reflex in comatose intensive care patients usually indicates that intracranial perfusion is about to be abolished.


METHODS
A 71-year-old man suffered an attack during which he became comatose. After 14 hours he developed polyuria, dilated fixed pupils and Cushing reflex. The cause was believed to be a global anoxic brain oedema. Coma, apnoea and absent brain stem reflexes suggested brain death.


RESULTS
Angiography with contrast injected into the aortic arch showed preserved circulation in both internal carotid, middle and anterior cerebral arteries, but absence of basilar artery circulation. A cerebral CT scan was initially normal, but 14 hours later a new scan demonstrated infarction of the brain stem, cerebellum and occipital lobes. The Norwegian criteria for organ donation were not fulfilled as these require stop of all intracranial circulation. The respirator was disconnected and the patient died.


CONCLUSIONS
The Cushing reflex can be seen after profound ischaemia in the posterior cerebral circulation with preserved circulation to the forebrain. Ischaemia of the brain stem alone may be sufficient to elicit the Cushing reflex.
Nielsen
Erik Waage
EW
Anestesiavdelingen, Nordlandssykehuset, 8092 Bodø. erikwn@fagmed.uit.no
Alstadhaug
Karl Bjørnar
KB
Hugaas
Kjell Arne
KA
Salvesen
Rolf
R
D000368:Aged; D001921:Brain / Q000098:blood supply* / Q000000981:diagnostic imaging / Q000473:pathology; D001926:Brain Death / Q000503:physiopathology; D002545:Brain Ischemia / Q000473:pathology / Q000503:physiopathology; D002536:Cerebral Arteries / Q000000981:diagnostic imaging; D003128:Coma / Q000473:pathology / Q000503:physiopathology*; D004677:Encephalocele / Q000473:pathology / Q000503:physiopathology; D017809:Fatal Outcome; D006801:Humans; D007427:Intracranial Pressure; D008297:Male; D012018:Reflex; D014057:Tomography, X-Ray Computed