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Cushing's ulcer: Further reflections
William J Kemp1, Asif Bashir2, Haitham Dababneh2
1Department of Neurological Surgery, Goodman Campbell Brain and Spine, Indiana University School of Medicine, Indianapolis, IN, USA.
Insights
Increased intracranial pressure from brain injuries can overstimulate the vagus nerve, leading to Cushing's ulcers. Harvey Cushing's research highlights this connection between neurological conditions and gastrointestinal issues.
Area of Science:
- Neurology
- Gastroenterology
- Medical History
Background:
- Intracranial processes like brain tumors and head injuries can elevate intracranial pressure.
- Elevated intracranial pressure may lead to vagus nerve overstimulation.
- This overstimulation can increase gastric acid secretion, resulting in Cushing's ulcers.
Purpose of the Study:
- To review Dr. Harvey Cushing's patient records and literature on gastro-duodenal ulcers.
- To understand Cushing's perspective on the phenomenon by examining unreported cases.
- To investigate the link between neurological conditions and ulcer formation.
Main Methods:
- Review of original patient records from Dr. Harvey Cushing's practice.
- Analysis of available medical literature on gastro-duodenal ulcers.
- Examination of clinical records of patients not previously reported by Cushing.
Main Results:
- Cushing's Yale Registry demonstrated that brain tumors or lesions can disrupt neural pathways, causing gastroduodenal ulceration.
- Cushing hypothesized that posterior fossa cerebellar operations could lead to ulcers via brain stem disturbances.
- The study links intracranial lesions to gastrointestinal complications.
Conclusions:
- Harvey Cushing's foundational work provides a basis for further research into the neurological pathways of ulcer formation.
- The Yale registry is a significant resource for understanding Cushing's ulcers.
- Continued research is needed to fully elucidate the mechanisms involved.
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."
Conclusion:
Harvey Cushing's pioneering work depicted in his Yale registry serves as a milestone for continuing research that can further discern this pathway.
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