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The Cushing Response: a case for a review of its role as a physiological reflex

Wei Hwang Wan1, Beng Ti Ang, Ernest Wang

  • 1Department of Neurosurgery, National Neuroscience Institute, 11 Jalan Tan Tock Seng, Singapore 308433, Singapore.

Journal of Clinical Neuroscience : Official Journal of the Neurosurgical Society of Australasia
|January 10, 2008
PubMed

Insights

The Cushing response (CR), a rise in blood pressure and slow heart rate due to high intracranial pressure, may be a protective baroreflex. A case study of subarachnoid hemorrhage supports this physiological role.

Area of Science:

  • Neuroscience
  • Physiology
  • Neurology

Background:

  • The Cushing response (CR), characterized by hypertension and bradycardia, is traditionally linked to brainstem compression from elevated intracranial pressure (ICP).
  • Controversy persists regarding the physiological relevance of CR, with an alternative hypothesis suggesting it acts as a baroreflex to maintain cerebral perfusion during critical ICP elevations or brainstem ischemia.

Observation:

  • A patient with spontaneous subarachnoid hemorrhage presented with a clear Cushing response.
  • The Cushing response in this patient spontaneously resolved, leading to an ultimately favorable clinical outcome.

Findings:

  • The observed self-aborting Cushing response in a subarachnoid hemorrhage patient challenges the notion of CR solely as a pre-terminal sign of brainstem damage.
  • The clinical course suggests a potential adaptive or protective mechanism rather than a purely pathological one.

Implications:

  • This case provides further evidence supporting the baroreflex hypothesis for the physiological role of the Cushing response.
  • Understanding CR as a potential compensatory mechanism may influence clinical management strategies for conditions involving elevated intracranial pressure.

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