The Cushing reflex (Cushing response) is a late and ominous sign of raised intracranial pressure and consists of which triad?

• A Hypotension, tachycardia, and Cheyne-Stokes breathing
• B Hypertension, tachycardia, and dilated pupils
• C Bradycardia, papilloedema, and sixth nerve palsy
• D Hypertension, bradycardia, and irregular respiration ✓

Explanation

The Cushing reflex (also called vasopressor response) occurs when ICP approaches mean arterial pressure and brainstem ischaemia triggers a sympathetic surge. It manifests as hypertension (to maintain CPP), reflex bradycardia (baroreceptor response to hypertension), and irregular or slow respiration (Biot or ataxic breathing from medullary compression). It indicates impending brainstem herniation and is a sign that surgical or medical decompression must occur urgently. It is distinct from simple papilloedema which is an earlier sign.

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

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