The Cushing reflex (vasopressor response) is a physiological response to acute raised intracranial pressure. Which triad characterizes it, and what is its clinical significance?

• A Tachycardia, hypertension, and tachypnea — indicates compensated raised ICP
• B Hypotension, bradycardia, and apnea — indicates terminal brainstem failure
• C Hypertension, bradycardia, and irregular respirations — indicates impending brainstem herniation ✓
• D Hypertension, tachycardia, and Cheyne-Stokes breathing — indicates early midbrain herniation

Explanation

The Cushing reflex (Cushing's triad) = hypertension (often with widened pulse pressure), bradycardia, and irregular respirations. It occurs as a last-ditch effort to maintain cerebral perfusion when ICP rises near mean arterial pressure — the systemic BP rises (driven by catecholamines from the brainstem ischemic area) and bradycardia results from baroreflex response to hypertension. Irregular breathing (Cheyne-Stokes or Biot's) reflects brainstem involvement. This is a pre-terminal sign indicating incipient tonsillar/uncal herniation and demands immediate ICP-lowering measures (mannitol, hyperventilation, surgical decompression).

Reference: Bailey & Love's Short Practice of Surgery, 27th ed.

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Written and medically reviewed by the StethoPrep medical team.