The Cushing's triad is a life-threatening symptom complex that can lead to stroke or intracranial hemorrhage. High blood pressure, slow heart rate and rapid breathing require immediate medical attention. When does the Cushing's triad occur and how is intracranial hypertension treated?

Cushing's triadis a condition that poses a direct threat to life. It results from elevated intracranial pressure - the pressure of the cerebrospinal fluid exceeds the norm: 50-200 mmH2O (millimeters of water) - which in turn leads to oppression of the brain structures responsible for the regulation of blood pressure, heart rate and respiration. The Cushing triad then manifests itself:

  • bradycardia - slow heart rate
  • hypertension
  • rapid breathing (tachypnea), which often slows down gradually more and more (bradypnoe)

What causes the Cushing triad?

Imagine a brain. It is the soft tissue that surrounds the skull, or bone dome. In addition, it closely surrounds, so even a slight increase in volume or mass inside the skull causes pressure on individual brain structures (in the Cushing's triad to those mentioned above), and also increases intracranial pressure.

There are several reasons why intracranial pressure can rise dangerously:

  • build-up of cerebrospinal fluid - this can happen with hydrocephalus (caused by pressure from a tumor, intraventricular hemorrhage, meningitis) or an overproduction of cerebrospinal fluid. The overproduction is often caused by the choroid plexus papilloma - this is a type of cancer that mostly affects children;
  • mass effect damage - can be caused by e.g. a tumor, hematoma, air, abscess, foreign body
  • vascular changes - too much blood may flow into the brain (this causes some disturbances in blood flow regulation). Other pathologies include, for example, insufficient blood supply or outflow resulting from venous embolism or sinus thrombosis.
  • cerebral edema - caused by vascular damage by a tumor, infection, contusion (called vasogenic), ischemia (cytotoxic), hydrocephalus (hydrostatic), or a decrease in the level of sodium in the blood (hypo-osmolar).

First aid in case ofpeople with Cushing's triad

In any suspected intracranial hypertension, the patient should be hospitalized. First, the doctor must control the symptoms that may be obstructing the test. For example, the patient may be very nervous, have very serious breathing problems, complain of pain. Therefore, painkillers, if necessary antipyretic, oxygen are administered. The examinations of choice are computed tomography (non-contrast) and magnetic resonance imaging. Intracranial pressure is also measured during lumbar puncture or through a special drain inserted into the ventricle of the brain. In addition, the patient should:

  • clear the airways, sometimes intubation is needed
  • keep the head in a straight line with the body, raised on a support about 30-40 degrees.
  • give mannitol (osmotically active diuretic) and then furosemide to intensify the anti-oedematous effect
  • perform short-term hyperventilation

Treatment of intracranial hypertension

If you are diagnosed with intracranial hypertension, use the symptoms of the Cushing's triad to promptly find the reason why the pressure is rising so much. By removing the cause, the pressure will drop. It can be suitably:

  • decompression of excess fluid - although you still need to find and remove the reason why it accumulated
  • removal of the skull scales can also help temporarily
  • in case of meningitis, treat the infection
  • removal of the oppressive tumor, abscess or hematoma
  • vascular failure treatment
  • electrolyte leveling
About the authorMarta Uler A journalist specializing in he alth, beauty and psychology. She is also a diet therapist by education. Her interests are medicine, herbal medicine, yoga, vegetarian cuisine and cats. I am a mother of two boys - a 10-year-old and a 6-month-old.

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Category:

Neurology