Cushing's triad

Cushing's triad is a clinical triad variably defined as either hypertension, bradycardia, and irregular respiration ^[1], or less commonly as widened pulse pressure (with elevated systolic and a either elevated or normal diastolic BP), irregular respiration, and bradycardia.^[2] It is sign of increased intracranial pressure, and it occurs as a result of the Cushing reflex.

It should not be confused with Cushing's syndrome, a disease state resulting from the elevated levels of blood cortisol.

Significance

Identification of the triad is important in emergency medicine because it suggests severe pressure within the cranial vault. This can be the result of cerebral hemorrhage, possibly due to a ruptured aneurysm or other cerebrovascular accident (a hemorrhagic stroke) or head trauma resulting in concussion and associated intracranial bleeding either within or outside the meninges (a subdural or epidural hemorrhage). It can also be due to an enlarging space-occupying lesion (a brain tumor). All of these events lead to the possibility of brain herniation, which can be rapidly fatal.

Eponym

It is named after Harvey Williams Cushing (1869-1939), an American neurosurgeon.

See also

• Cushing reflex
• Cheyne-Stokes respiration

References

1. ^ Mayer, S.A.; Chong, J.Y. (2002). "Critical care management of increased intracranial pressure". Journal of intensive care medicine (Wiley Online Library) 17 (2): 55–67. 
2. ^ Ayling, J (2002). "Managing head injuries". Emergency Medical Services 31 (8): 42. PMID 12224233. 

External links

• Cushing triad - whonamedit.com

PNS

Reflexes of extremities/ corticospinal tract	Combination Jendrassik maneuver Lower limb Babinski sign · Chaddock reflex · Oppenheim's sign · Westphal's sign Upper limb Hoffmann's sign
Other torso/limbs	Upper limb Froment's sign · carpal tunnel syndrome (Tinel sign, Phalen maneuver) Lower limb Abadie's sign of tabes dorsalis · Gowers' sign · Hoover's sign · Lasègue's sign · Trendelenburg's sign Torso Beevor's sign General Todd's paresis · Jolly's test

Mental/behavioral

Russell's sign

M: PNS anat(h/r/t/c/b/l/s/a)/phys(r)/devp/prot/nttr/nttm/ntrp noco/auto/cong/tumr, sysi/epon, injr proc, drug(N1B)

M: PSO/PSI mepr dsrd (o, p, m, p, a, d, s), sysi/epon, spvo proc(eval/thrp), drug(N5A/5B/5C/6A/6B/6D)