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

Journal of Clinical Neuroscience

Volumn 15, Issue 3, 2008, Pages 223-228

  Wan, Wei Hwang ^a   Ang, Beng Ti ^a   Wang, Ernest ^a  

^a NATIONAL NEUROSCIENCE INSTITUTE   (Singapore)

Author keywords

Cerebral autoregulation; Cushing response; Raised intracranial pressure

Indexed keywords

AMLODIPINE; ANTIHYPERTENSIVE AGENT; CAPTOPRIL; NIMODIPINE; PHENYTOIN;

APNEA; BRADYCARDIA; BRAIN ANGIOGRAPHY; BRAIN DAMAGE; BRAIN DISEASE; BRAIN ISCHEMIA; BRAIN PERFUSION; BRAIN STEM; BRAIN VASOSPASM; CIGARETTE SMOKING; CLINICAL FEATURE; COMPUTER ASSISTED TOMOGRAPHY; CUSHING RESPONSE; DRUG DOSE TITRATION; EMERGENCY WARD; FOLLOW UP; HEADACHE; HOSPITAL ADMISSION; HOSPITAL DISCHARGE; HUMAN; HYPERTENSION; INTENSIVE CARE UNIT; INTRACRANIAL PRESSURE; NECK PAIN; NEUROLOGIC EXAMINATION; PHYSICAL EXAMINATION; PHYSIOLOGY; PRESSORECEPTOR REFLEX; PRIORITY JOURNAL; REVIEW; SINGLE DRUG DOSE; SUBARACHNOID HEMORRHAGE; TREATMENT OUTCOME;

ANIMALS; BAROREFLEX; CEREBRAL ANGIOGRAPHY; CUSHING SYNDROME; HUMANS; INTRACRANIAL HYPERTENSION; MALE; MIDDLE AGED; TOMOGRAPHY, X-RAY COMPUTED;

EID: 38949117562     PISSN: 09675868     EISSN: None     Source Type: Journal    
DOI: 10.1016/j.jocn.2007.05.025     Document Type: Review

References (20)

1. Cushing H. Concerning a definite regulatory mechanism of the vaso-motor centre which controls blood pressure during cerebral compression. Bull Johns Hopkins Hosp 12 (1901) 290-292
2. Heymans C. The control of heart rate consequent to changes in the cephalic blood pressure and in the intracranial pressure. Am J Physiol 85 (1928) 498-505
3. Guyton A.C. Arterial Pressure and Hypertension (1980), Saunders, Philadelphia
4. Pasztor E., Fedina L., Kocsis B., et al. Activity of peripheral sympathetic efferent nerves in experimental subarachnoid haemorrhage. Part 1: Observations at the time of intracranial hypertension. Acta Neurochir (Wien) 79 (1986) 125-131
5. Fitch W., McDowall D.G., Keaney N.P., et al. Systemic vascular responses to increased intracranial pressure. 2. The 'Cushing' response in the presence of intracranial space-occupying lesions: Systemic and cerebral haemodynamic studies in the dog and the baboon. J Neurol Neurosurg Psychiatry 40 (1977) 843-852
6. Ebel H., Rust D.S., Leschinger A., et al. Vasomotion, regional cerebral blood flow and intracranial pressure after induced subarachnoid haemorrhage in rats. Zentralbl Neurochir 57 (1996) 150-155
7. Dickinson C.J. Reappraisal of the Cushing reflex: the most powerful neural blood pressure stabilizing system. Clin Sci 79 (1990) 543-550
8. van Loon J., Shivalkar B., Plets C., et al. Catecholamine response to a gradual increase of intracranial pressure. J Neurosurg 79 (1993) 705-709
9. Barbiro-Michaely E., and Mayevsky A. Effects of elevated ICP on brain function: Can the multiparametric monitoring system detect the 'Cushing Response'?. Neurol Res 25 (2003) 42-52
10. Marshiman L.A. Cushing's 'variant' response (acute hypotension) after subarachnoid hemorrhage. Association with moderate intracranial tension and subacute cardiovascular collapse. Stroke 28 (1997) 1445-1450
11. Plets C. Arterial hypertension in neurosurgical emergencies. Am J Cardiol 63 (1989) 40C-42C
12. Schmidt E.A., Czosnyka Z., Momjian S., et al. Intracranial baroreflex yielding an early Cushing response in human. Acta Neurochir 95 (2005) 253-256
13. Nakamura K., Osborn Jr. J.W., and Cowley Jr. A.W. Pressor response to small elevations of cerebroventricular pressure in conscious rats. Hypertension 10 (1987) 635-641
14. Guyenet P.G., and Brown D.L. Unit activity in nucleus paragigantocellularis lateralis during cerebral ischemia in the rat. Brain Res 364 (1986) 301-314
15. Sun M.K., and Reis D.J. Differential responses of barosensitive neurons of rostral ventrolateral medulla to hypoxia in rats. Brain Res 609 (1993) 333-337
16. Sun M.K., and Reis D.J. Hypoxia-activated Ca currents in pacemaker neurons of rat rostral ventrolateral medulla in vitro. J Physiol Lond 476 (1994) 101-116
17. Sun M.K., and Reis D.J. Central neural mechanisms mediating excitation of sympathetic neurons by hypoxia. Prog Neurobiol 44 (1994) 197-219
18. Chan J.Y.H., Chang A.Y.W., and Chan S.H.H. New insights on brain stem death: From bedside to bench. Prog Neurobiol 77 (2005) 396-425
19. Nielsen E.W., Alstadhaug K.B., Hugaas K.A., et al. A 71-year-old man with Cushing reflex. Tidsskr Nor Laegeforen 124 (2004) 943-945
20. Kalmar A.F., Aken J.V., Caemaert J., et al. Value of Cushing Reflex as warning sign for brain ischemia during neuroendoscopy. Br J Anaes 94 (2005) 791-799