A patient with a large intracerebral hemorrhage develops systolic hypertension of 220 mmHg, bradycardia of 40/min, and irregular respiration. This combination indicates:
- A Acute rise in intracranial pressure with impending herniation ✓
- B Loss of cerebral autoregulation due to chronic hypertension
- C Neurogenic pulmonary edema from sympathetic storm
- D Brainstem stroke involving the nucleus tractus solitarius
Correct answer: A. Acute rise in intracranial pressure with impending herniation
Explanation
The Cushing reflex, hypertension with reflex bradycardia and irregular breathing, is the classic sign of acutely raised intracranial pressure approaching herniation. Rising ICP reduces cerebral perfusion pressure, and the medullary vasomotor center drives intense sympathetic vasoconstriction to restore perfusion; the resulting hypertension triggers baroreceptor-mediated bradycardia. Chronic hypertension shifts the autoregulation curve without producing this triad, and a solitary nucleus lesion causes hypotension rather than this pressor response.
Reference: Guyton and Hall Textbook of Medical Physiology, 14th ed.
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