title: Cushing's ulcer: Further reflections.
abstract: BACKGROUND
  Brain tumors, traumatic head injury, and other intracranial processes including infections, can cause increased intracranial pressure and lead to overstimulation of the vagus nerve. As a result, increased secretion of gastric acid may occur which leads to gastro-duodenal ulcer formation known as Cushing's ulcer.
  
  
  METHODS
  A review of original records of Dr. Harvey Cushing's patients suffering from gastro-duodenal ulcers was performed followed by a discussion of the available literature. We also reviewed the clinical records of the patients never reported by Cushing to gain his perspective in describing this phenomenon. Dr. Cushing was intrigued to investigate gastro-duodenal ulcers as he lost patients to acute gastrointestinal perforations following successful brain tumor operations. It is indeed ironic that Harvey Cushing developed a gastro-duodenal ulcer in his later years with failing health.
  
  
  RESULTS
  Clinically shown by Cushing's Yale Registry, a tumor or lesion can disrupt this circuitry, leading to gastroduodenal ulceration. Cushing said that it was "reasonable to believe that the perforations following posterior fossa cerebellar operations were produced in like fashion by an irritative disturbance either of fiber tracts or vagal centers in the brain stem."
  
  
  CONCLUSIONS
  Harvey Cushing's pioneering work depicted in his Yale registry serves as a milestone for continuing research that can further discern this pathway.
authors.affiliation: Department of Neurological Surgery, Goodman Campbell Brain and Spine, Indiana University School of Medicine, Indianapolis, IN, USA.
authors.forename: William J
authors.initials: WJ
authors.lastname: Kemp
authors.affiliation: Department of Neurosurgery, JFK New Jersey Neuroscience Institute at Seton Hall University, Edison, NJ, USA.
authors.forename: Asif
authors.initials: A
authors.lastname: Bashir
authors.affiliation: Department of Neurosurgery, JFK New Jersey Neuroscience Institute at Seton Hall University, Edison, NJ, USA.
authors.forename: Haitham
authors.initials: H
authors.lastname: Dababneh
authors.affiliation: Department of Neurological Surgery, Goodman Campbell Brain and Spine, Indiana University School of Medicine, Indianapolis, IN, USA.
authors.forename: Aaron A
authors.initials: AA
authors.lastname: Cohen-Gadol
keywords: Brain neoplasms; duodenal ulcer; gastric ulcer; intracranial pressure