The Cushing Response: a case for a review of its role as a physiological reflex.
Despite a century of work on the subject, controversy still exists as to the physiological relevance of the Cushing response (CR), a state of raised systemic blood pressure and bradycardia associated with raised intracranial pressure. The alternative that has been proposed to the classical belief of pre-terminal brainstem damage is of a baroreflex that attempts to maintain cerebral perfusion in response to situations of extreme elevations in intracranial pressure or brainstem ischemia. We report a patient with spontaneous subarachnoid haemorrhage who demonstrated CR, which was later seen to self-abort with an eventual good outcome. We review the existing literature and propose that our clinical case may provide further support for a physiological role of CR.
Wan
Wei Hwang
WH
Department of Neurosurgery, National Neuroscience Institute, 11 Jalan Tan Tock Seng, Singapore 308433, Singapore.
Ang
Beng Ti
BT
Wang
Ernest
E
D000818:Animals; D017704:Baroreflex / Q000502:physiology*; D002533:Cerebral Angiography / Q000379:methods; D003480:Cushing Syndrome / Q000473:pathology / Q000503:physiopathology*; D006801:Humans; D019586:Intracranial Hypertension / Q000209:etiology; D008297:Male; D008875:Middle Aged; D014057:Tomography, X-Ray Computed