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[A 71-year-old man with Cushing reflex]
Erik Waage Nielsen1, Karl Bjørnar Alstadhaug, Kjell Arne Hugaas
1Anestesiavdelingen, Nordlandssykehuset, 8092 Bodø. erikwn@fagmed.uit.no
Summary
The Cushing reflex in comatose patients can indicate impending loss of intracranial blood flow. This reflex may occur even with preserved forebrain circulation, suggesting isolated brainstem ischemia is sufficient to trigger it.
Area of Science:
- Neurology
- Critical Care Medicine
- Neuroscience
Background:
- The Cushing reflex is a critical sign in comatose patients, typically signaling imminent cessation of intracranial perfusion.
- Understanding the reflex's triggers is vital for managing patients with severe brain injury.
Observation:
- A case study of a 71-year-old male who developed coma, polyuria, fixed dilated pupils, and the Cushing reflex 14 hours after an initial event.
- Initial assessment suggested global anoxic brain edema, with coma and absent brainstem reflexes indicating brain death.
Findings:
- Cerebral angiography revealed preserved anterior circulation but absent basilar artery flow.
- A delayed cerebral CT scan showed brainstem, cerebellum, and occipital lobe infarction.
- The Cushing reflex was observed despite preserved forebrain circulation, indicating posterior circulation ischemia.
Implications:
- The Cushing reflex can manifest in cases of profound posterior cerebral circulation ischemia with intact anterior circulation.
- Isolated brainstem ischemia may be sufficient to elicit the Cushing reflex, broadening its diagnostic significance.
- This finding refines the understanding of Cushing reflex pathophysiology in severe neurological injury.