380:, or homeostatic mechanism for the maintenance of blood pressure, in the cranial region. Specifically, the reflex mechanism can maintain normal cerebral blood flow and pressure under stressful situations such as ischemia or subarachnoid hemorrhages. A case report of a patient who underwent a spontaneous subarachnoid hemorrhage demonstrated that the Cushing reflex played a part in maintaining cerebral perfusion pressure (CPP) and cerebral blood flow. Eventually, the ICP drops to a level range where a state of induced hypertension in the form of the Cushing reflex is no longer required. The Cushing reflex was then aborted, and CPP was maintained. It has also been shown that an increase in mean arterial pressure due to hypertension, characteristic of the reflex, can cause the normalization of CPP. This effect is protective, especially during increased intracranial pressure, which creates a drop in CPP.
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643:. The anesthesia used in experiments have led to respiratory depression, which might have had effect on the results. Early experiments also put animal subjects under artificial ventilation, only allowing for limited conclusions about respiration in the Cushing reflex. The use of anesthetics proposes ideas for future research, since the creation of the Cushing response has been difficult to create under basal conditions or without anesthesia.
333:. The blood pressure can be expected to remain higher than the pressure of the raised cerebral spinal fluid to continue to allow blood to flow to the brain. The pressure rises to the point where it overcomes the resisting pressure of the compressed artery, and blood is allowed through, providing oxygen to the hypoxic area of the brain. If the increase in blood pressure is not sufficient to compensate for the compression on the artery,
237:. In one study, it was confirmed that raised ICP due to subarachnoid hemorrhaging causes mechanical distortion of the brainstem, specifically the medulla. Due to the mechanism of the Cushing reflex, brainstem distortion is then swiftly followed by sympathetic nervous system over activity. In addition, during typical neurosurgical procedures on patients, especially those involving neuroendoscopic techniques, frequent washing of the
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484:. In June 1901 Cushing published his first paper through Johns Hopkins Hospital Bulletin entitled "Concerning a definite regulatory mechanism of the vasomotor centre which controls blood pressure during cerebral compression". Between 1901 and 1903, Cushing published five papers pertaining to his research on the vasopressor response. These papers were published in
561:, and others experimented with intracranial pressure similarly to Cushing. Some of these researchers published similar findings concerning the relationship of intracranial pressure to arterial blood pressure before Cushing had begun experimenting. Cushing studied this relationship more carefully and offered an improved explanation of the relationship.
325:. This induces bradycardia, or slowed heart rate, and signifies the second stage of the reflex. Bradycardia may also be caused by increased ICP due to direct mechanical distortion of the vagus nerve and subsequent parasympathetic response. Furthermore, this reflexive increase in parasympathetic activity is thought to contribute to the formation of
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neurosurgery being performed on the brain, there is always a likelihood that raised intracranial pressure may occur. Early recognition of this is crucial to the well being of the patient. Although direct measurement of ICP is possible, it is not always accurate. In the past, physicians and nurses have relied on
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This research clearly displayed the cause and effect relationship between intracranial pressure and cerebral compression. Cushing noted this relationship in his subsequent publications. He also noted that there must exist a specific regulatory mechanism that increased blood pressure to a high enough
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or bradycardia, the late phase of the reflex, to identify the ICP increase. Once the initial stage of the
Cushing reflex (bradycardia combined with hypertension) was discovered, it offered a much more reliable and swift warning sign of high ICP. It was found that hypertension and bradycardia occurred
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and venous blood pressure. Like Hill, Cushing used dogs for his experiments. To begin, Cushing monitored the caliber and color of cortical vessels by fitting a glass window into the skull of the dog. Intracranial pressure was raised by filling an intracranial, soft, rubber bag with mercury. Cushing
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in the
Cushing reflex is unclear. In most normal pressure responses the chemoreceptors and baroreceptors work together to increase or decrease blood pressure. In the Cushing reflex, the central chemoreceptors are likely involved in the detection of ischemia, contributing to the sympathetic surge and
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As first postulated by Harvey
Cushing, raised intracranial pressure is the primary cause of the Cushing reflex. Furthermore, continued moderate increases in cranial pressure allows for the Cushing reflex to occur. In contrast, rapid and dramatic pressure rises do not allow for the mechanism of the
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Brain plateau wave changes are also associated with the
Cushing reflex. These waves are characterized by acute rises of the ICP, and are accompanied by a decrease of the cerebral perfusion pressure. It has been found that if a Cushing reflex occurs, brain plateau wave changes can be erased due to
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is exhibited as an increase in rate rather than depth of ventilation, so the
Cushing reflex is often associated with slow, irregular breathing. As a result of the now defective regulation of heart rate and blood pressure, the physiologic response is decreased blood flow peripherally, which can
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Whenever a
Cushing reflex occurs, there is a high probability of death in seconds to minutes. As a result, a Cushing reflex indicates a need for immediate care. Since its presence is a good detector of high ICP, it is often useful in the medical field, particularly during surgery. During any
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mediating the
Cushing response is also unknown. Some research suggests the existence of intracranial baroreceptors to trigger specific Cushing baroreceptor reflex. Experiments by Schmidt and his fellow researchers showed that the Cushing reflex is directed by
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Some researchers have also suggested a long-term effect of the
Cushing reflex. Thus far it has only been observed as an immediate acute response, but there has been some evidence to suggest that its effects could be prolonged, such as a long-term raise in
635:, while others have reported increased respiratory rates. Other researchers have found that increases in respiratory rate follow ICP decreases, while others say it is a response to ICP increase. One must also take into account the use of
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is located in an area surrounded by the skull, increased ICP consequently increases the pressure in the fluid itself. The pressure in the cerebral spinal fluid eventually rises to the point that it meets and gradually exceeds the
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have been known to cause high intracranial pressure. The
Cushing reflex can also result from low CPP, specifically below 15 mmHg. CPP normally falls between 70-90 mmHg in an adult human, and 60-90 mmHg in children.
1178:
Pasztor, E; Fedina L; Kocsis B; et al. (1986). "Activity of peripheral sympathetic efferent nerves in experimental subarachnoid haemorrhage. Part 1: Observations at the time of intracranial hypertension".
568:, a German pathologist and contemporary of Cushing, made remarks claiming that Cushing neither cited him in Cushing's research nor expanded on any of the results that he had found in his original experiments.
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In response to rising intracranial pressure (ICP), respiratory cycles change in regularity and rate. Different patterns indicate a different location of the brain where the injury occurred. The increase in
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Subarachnoid hemorrhage as shown on a CT scan. It is denoted by the arrow. This type of injury may result in damage to the brainstem, which could initiate or worsen the symptoms of the
Cushing reflex
182:(CPP) dropped below 15 mmHg due to raised ICP. Also, the Cushing reflex is known to arise only from acute prolonged raises in ICP. Thus, it can be used as a tool by physicians to differentiate
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Marshman, LA (1997). "Cushing's 'variant' response (acute hypotension) after subarachnoid hemorrhage. Association with moderate intracra- nial tension and subacute cardiovascular collapse".
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point such that it did not create anemic conditions. Cushing's publications contain his observations and no statistical analysis. The sample size of the experiment is also not known.
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The underlying mechanisms of the reflex on a cellular level are yet to be discovered, and will likely be the next area of research if scientists and or doctors chose to do so.
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of the disease remains undetermined. The possibility that intracranial pressure (ICP) may not be the sole cause of the Cushing reflex per se came from an occurrence of Cushing
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Ogilvy, CS; Dubois AB (1987). "Effect of increased intracranial pressure on blood pressure, heart rate, respiration and catecholamine levels in neonatal and adult rabbits".
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are activated. In the first stage of the reflex, sympathetic nervous system stimulation is much greater than parasympathetic stimulation. The sympathetic response activates
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hypertension in the first phase of the reflex, and work in opposition to the baroreceptors, contributing to the combined high sympathetic and parasympathetic activation.
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100:
Defect of the blood–brain barrier after stroke shown in T1-weighted MRI images. Left image without, right image with contrast medium administration showing evidence of
298:. The body's induced hypertension is an attempt to restore blood flow to the ischemic brain. The sympathetic stimulation also increases the rate of heart
1399:
Guyton, Arthur; Hall, John (2006). "Chapter 18: Nervous Regulation of Circulation, and a Rapid Control of Arterial Pressure". In Gruliow, Rebecca (ed.).
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Although the Cushing reflex was primarily identified as a physiological response when blood flow has almost ceased, its activity has also been seen in
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is affected by the Cushing reflex, though the respiratory changes induced are still an area that needs more research. Some researchers have reported
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It has also been reported that the presence of a Cushing reflex due to an ICP increase could allow one to conclude that ischemia has occurred in the
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first expanded knowledge of what is now known as the Cushing reflex, there are still many aspects of the research that remain to be seen. The exact
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368:, which is detrimental to the physiological well-being of patients. As a result, the Cushing reflex is a last-ditch effort by the body to maintain
1707:
Schmidt EA, Czosnyka Z, Momjian S, Czosnyka M, Bech RA, Pickard JD (2005). "Intracranial baroreflex yielding an early cushing response in human".
1778:
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Hanigan, WC; W. Ragen; M. Ludgera (1992). "Neurological surgery in the nineteenth century: the principles and techniques of Ernst von Bergmann".
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The Cushing reflex is complex and seemingly paradoxical. The reflex begins when some event causes increased intracranial pressure (ICP). Since
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response occurring before increased ICP. Some research observed symptoms of Cushing reflex, without the usual increased ICP and medullary
152:, etc.), which reflect decreased intravascular blood flow. This decreased flow often causes a reflexive HTN, or hypertension (increase in
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Kalmar, AF; JV Aken; J Caemaert; et al. (2005). "Value of Cushing Reflex as warning sign for brain ischemia during neuroendoscopy".
651:. Heightened sensitivity of neurological response systems leading to arterial hypertension is also possible, but has not been examined.
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344:. Since the brainstem controls involuntary breathing, changes in its homeostasis often results in irregular respiratory pattern and/or
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reflex to sufficiently take place. Elevated intracranial pressure can result from numerous pathways of brain impairment, including:
123:), and irregular respiration. It is caused by increased pressure inside the skull. These symptoms can be indicative of insufficient
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209:. As such, the presence of a Cushing reflex due to ICP can indicate that ischemia may be occurring due to foreign organ rejection.
476:. He continued to work on the same research project, while also simultaneously improving his methods of recording coincidence of
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Kosieradzki, M; W Rowinski (December 2008). "Ischemia/reperfusion injury in kidney transplantation: mechanisms and prevention".
768:"Concerning a definite regulatory mechanism of the vasomotor centre which controls blood pressure during cerebral compression"
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1525:
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Woodman, OL; SF Vatner (August 1987). "Coronary vasoconstriction mediated by α1- and α2-adrenoceptors in conscious dogs".
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Wan, WH; BT Ang; E Wang (Jan 7, 2008). "The cushing response: A case for a review of its role as a physiological reflex".
294:. This constriction raises the total resistance of blood flow, elevating blood pressure to high levels, which is known as
1269:"Cerebral blood flow changes in response to elevated intracranial pressure in rabbits and bluefish: a comparative study"
17:
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Jones, JV (1989-02-02). "Differentiation and investigation of primary versus secondary hypertension (Cushing reflex)".
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Dickinson, CJ (1990). "Reappraisal of the Cushing reflex: the most powerful neural blood pressure stabilizing system".
991:
Fox JL, Ransdell AM, Al-Mefty O, Jinkins JR (1986). "The Cushing reflex in the absence of intracranial hypertension".
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Dagal, A; Lam AM (April 2011). "Cerebral blood flow and the injured brain: how should we monitor and manipulate it?".
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Cushing began experimenting once he obtained approval from Kocher. His experimental setup was a modified version of
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Raised ICP, tachycardia, or some other endogenous stimulus can result in distortion and/or increased pressure on the
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become compressed. Compression then results in diminished blood supply to the brain, a condition known as cerebral
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life. This activity has not been thoroughly investigated, so there is a need for more research in this area.
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179:
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Reis DJ, Nathan MA, Doba N (1975). "Two specific brainstem systems which regulate the blood pressure".
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model to similarly test the effects of brain pressure on sinus pressure, cerebrospinal fluid pressure,
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to begin testing how compression of the brain affected blood vessels. Cushing also enlisted the aid of
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148:. These are simply pathologic waves seen in HR tracings (i.e., arterial lines, electrocardiograph (
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response, ischemia in the cranial region has been detected with a transplanted organ that is being
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197:. Finally, the Cushing reflex may be one of many ways to identify if a patient has rejected a
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in early experimentation. Research was initially performed on animals or patients under
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detect the increase in blood pressure and trigger a parasympathetic response via the
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About Intracranial Pressure and Blood Circulation Inside the Cranium. Medical Thesis
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Grady PA, Blaumanis OR (June 1988). "Physiologic parameters of the Cushing reflex".
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Fodstad H, Kelly PJ, Buchfelder M (November 2006). "History of the cushing reflex".
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Hackett, J.G.; F. M. Abboud; A. L. Mark; P. G. Schmid; D. D. Heistad (July 1972).
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Raised intracranial pressure can ultimately result in the shifting or crushing of
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Some controversy concerning plagiarism does surround some of Cushing's research.
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1360:"Coronary vascular responses to stimulation of chemoreceptors and baroreceptors"
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1403:(Book) (11th ed.). Philadelphia, Pennsylvania: Elsevier Inc. p. 213.
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1459:"Nervous Regulation of the Circulation and Rapid Control of Arterial Pressure"
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310:. This combined with hypertension is the first stage of the Cushing reflex.
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response and the Cushing reflex and its symptoms has yet to be identified.
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Irregular, decreased respirations (caused by impaired brainstem function)
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Physiological nervous system response to increased intracranial pressure
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1495:(3rd ed.). Sunderland, MA, USA: Sinauer Associates. p. 143.
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444:. A month into his trip, Cushing received a formal proposition from
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1711:. Acta Neurochirurgica Supplementum. Vol. 95. pp. 253–6.
612:, since its physiological change has to do with the balance of the
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assistance and resources, Cushing began his research. Cushing left
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simultaneously. This three part effect is commonly referred to as
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and similar drugs. It was first described in detail by American
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rather than increasing mercury content of an intracranial bag.
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592:, suggesting other causes that still require research. Axial
77:. It can also be seen after the intravenous administration of
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1520:(7th ed.). Jones and Bartlett Learning. p. 1665.
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Comparative Biochemistry and Physiology Part A: Physiology
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376:. It is widely accepted that the Cushing reflex acts as a
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The Cushing reflex classically presents as an increase in
57:) is a physiological nervous system response to increased
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Although a lot of progress has been made since 1901 when
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Several notable figures in the medical field, including
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refers to when all of these symptoms are seen together:
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156:) despite the actual decrease in intravascular volume.
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in the stomach, due to uncontrolled activation of the
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of increased blood pressure, irregular breathing, and
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69:. It is usually seen in the terminal stages of acute
1544:
Physiology and Pathology of the Cerebral Circulation
348:. This is the third and final stage of the reflex.
1425:
1345:The Central Nervous System: Structure and Function
1561:Mitchell Fink; Michelle Hayes; Neil Soni (2008).
499:
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1307:
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1347:. Oxford University Press US. pp. 369–396.
1267:Beiner, JM; CS Olgiyy; AB DuBois (March 1997).
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452:, a known blood pressure researcher. Utilizing
401:Systolic hypertension (widening pulse pressure)
1709:Intracranial Pressure and Brain Monitoring XII
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1463:Guyton and Hall Textbook of Medical Physiology
890:
513:recorded the intracranial pressure along with
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2128:
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620:. However, the specific relation between the
1613:Anatomic Studies of the Cerebral Circulation
1565:. London, England: Springer. pp. 89–90.
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697:Ayling, J (2002). "Managing head injuries".
1661:. Springfield: Charles C. Thomas. pp.
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1625:: CS1 maint: location missing publisher (
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306:. Increased heart rate is also known as
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1432:. Philadelphia: JB Lippincott. pp.
1424:P Barash; B Cullen; R Storlting (1992).
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290:, causing constriction of the body's
278:During the increase in ICP, both the
263:(MAP). When the ICP exceeds the MAP,
2850:oxygen–hemoglobin dissociation curve
1669:
1456:
873:
830:
627:It has been determined that rate of
544:
529:. In later experiments performed by
1832:
1493:Neuroanatomy through clinical cases
24:
2776:hypoxic pulmonary vasoconstriction
1119:10.1016/j.transproceed.2008.10.004
1011:
975:
816:10.1227/01.NEU.0000245582.08532.7C
383:
25:
2980:
839:Current Opinion in Anesthesiology
1615:. Paris, Bailliere. p. 642.
1590:10.1227/00006123-199205000-00017
1322:10.1152/ajpheart.1987.253.2.H388
432:. Cushing began his research in
421:Cushing's reflex is named after
1563:Classic Papers in Critical Care
1509:
1484:
1450:
1392:
1547:. London: J & A Churchill.
1465:, Elsevier, pp. 215–255,
1401:Textbook of Medical Physiology
810:(5): 1132–7, discussion 1137.
618:parasympathetic nervous system
500:Experimental setup and results
284:parasympathetic nervous system
13:
1:
2451:Symmetrical tonic neck reflex
1681:Clin. Exp. Pharmacol. Physiol
1518:Emergency Care in the Streets
1286:10.1016/s0300-9629(96)00206-x
681:
91:
2142:
1644:(Thesis). Wurzburg, Germany.
1084:10.1016/0002-9149(89)90398-6
905:10.1016/0090-3019(88)90140-1
851:10.1097/ACO.0b013e3283445898
288:alpha-1 adrenergic receptors
261:mean arterial blood pressure
249:
131:) as well as compression of
7:
2808:Ventilation/perfusion ratio
2659:pulmonary stretch receptors
1658:Harvey Cushing. A biography
664:
359:
246:disappearance of high ICP.
180:cerebral perfusion pressure
10:
2985:
2840:alveolar–arterial gradient
1900:Charcot's neurologic triad
1041:10.1016/j.jocn.2007.05.025
699:Emergency Medical Services
614:sympathetic nervous system
492:, and one was authored by
405:
280:sympathetic nervous system
73:and may indicate imminent
2959:Cardiovascular physiology
2913:
2789:
2763:
2721:respiratory minute volume
2674:
2633:ventral respiratory group
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2401:
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2254:
2201:
2150:
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2004:
1997:
1977:
1946:
1930:
1921:
1914:Peripheral nervous system
1912:
1873:
1823:
1815:Cranial nerve examination
1805:
33:(also referred to as the
2628:dorsal respiratory group
2522:obligate nasal breathing
1810:Neurological examination
1717:10.1007/3-211-32318-x_51
1640:Friedrich Jolly (1871).
1516:Caroline, Nancy (2013).
1491:Blumenfeld, Hal (2022).
1154:10.1161/01.str.28.7.1445
622:autonomic nervous system
610:autonomic nervous system
596:distortion could be the
472:, a previous student of
217:, ischemia, meningitis,
215:subarachnoid hemorrhages
201:. Aside from the innate
2830:pulmonary gas pressures
2444:Crossed extensor reflex
2193:Pharyngeal (gag) reflex
2184:Vestibulo-ocular reflex
772:Bull Johns Hopkins Hosp
423:Harvey Williams Cushing
267:located in the brain's
195:posterior cranial fossa
2584:mechanical ventilation
2493:Respiratory physiology
2219:Brachioradialis reflex
2160:Pupillary light reflex
2018:carpal tunnel syndrome
1825:Central nervous system
726:Biology of the Neonate
671:Traumatic brain injury
418:
353:central chemoreceptors
169:
160:Differential diagnosis
104:
61:(ICP) that results in
2835:alveolar gas equation
2771:pulmonary circulation
2391:Churchill–Cope reflex
2346:Bezold–Jarisch reflex
1882:Intracranial pressure
1541:Leonard Hill (1896).
1377:10.1161/01.res.31.1.8
440:studying abroad with
413:
178:93% of the time when
167:
99:
59:intracranial pressure
2890:respiratory quotient
2745:body plethysmography
2664:Hering–Breuer reflex
2539:pulmonary surfactant
2313:Superficial reflexes
2188:Oculocephalic reflex
2165:Accommodation reflex
2062:Trendelenburg's sign
417:, Doris Ulmann 1920s
35:vasopressor response
18:Cushing's triad
2733:Lung function tests
2567:hyperresponsiveness
2424:Golgi tendon reflex
2366:Oculocardiac reflex
2180:Caloric reflex test
1938:Jendrassik maneuver
1683:. Suppl 2: 179–83.
1457:Hall, John (2012),
1428:Clinical Anesthesia
1343:Per Brodal (2004).
1316:(2 Pt 2): H388–93.
766:Cushing, H (1901).
600:of Cushing reflex.
572:Research directions
494:Emil Theodor Kocher
460:in 1901 to work in
446:Emil Theodor Kocher
442:Emil Theodor Kocher
256:cerebrospinal fluid
175:hemodynamic changes
115:, reduction of the
2900:diffusion capacity
2895:arterial blood gas
2875:carbonic anhydrase
2609:pneumotaxic center
2381:Reflex tachycardia
2376:Reflex bradycardia
2325:Cremasteric reflex
2256:Primitive reflexes
2057:Straight leg raise
1795:Signs and symptoms
1655:JF Fulton (1946).
1246:10.1093/bja/aei121
1193:10.1007/bf01407456
999:(Suppl 47): 9–16.
551:Ernst von Bergmann
535:subarachnoid space
419:
199:transplanted organ
170:
105:
47:Cushing phenomenon
2946:
2945:
2854:Oxygen saturation
2820:zones of the lung
2559:airway resistance
2459:
2458:
2439:Withdrawal reflex
2341:Bainbridge reflex
2239:Ankle jerk reflex
2110:
2109:
2106:
2105:
2102:
2101:
1993:
1992:
1985:Hoffmann's reflex
1908:
1907:
1726:978-3-211-24336-7
1527:978-1-4496-4151-1
1502:978-1-60535-962-5
1410:978-0-7216-0240-0
961:10.1042/cs0790543
738:10.1159/000242728
676:Bainbridge reflex
545:Other researchers
16:(Redirected from
2976:
2755:nitrogen washout
2614:apneustic center
2529:respiratory rate
2486:
2479:
2472:
2463:
2462:
2434:Startle response
2409:List of reflexes
2320:Abdominal reflex
2203:Stretch reflexes
2137:
2130:
2123:
2114:
2113:
2002:
2001:
1964:Oppenheim's sign
1928:
1927:
1919:
1918:
1895:Lhermitte's sign
1830:
1829:
1797:relating to the
1788:
1781:
1774:
1765:
1764:
1759:
1758:
1752:
1748:
1746:
1738:
1704:
1693:
1692:
1676:
1667:
1666:
1652:
1646:
1645:
1637:
1631:
1630:
1624:
1616:
1611:Duret H (1878).
1608:
1602:
1601:
1573:
1567:
1566:
1558:
1549:
1548:
1538:
1532:
1531:
1513:
1507:
1506:
1488:
1482:
1481:
1480:
1479:
1454:
1448:
1447:
1431:
1421:
1415:
1414:
1396:
1390:
1389:
1379:
1355:
1349:
1348:
1340:
1334:
1333:
1305:
1299:
1298:
1288:
1264:
1258:
1257:
1239:
1219:
1213:
1212:
1175:
1166:
1165:
1137:
1131:
1130:
1107:Transplant. Proc
1102:
1096:
1095:
1067:
1061:
1060:
1024:
1009:
1008:
988:
973:
972:
949:Clinical Science
944:
917:
916:
888:
871:
870:
834:
828:
827:
799:
780:
779:
763:
750:
749:
721:
715:
714:
694:
523:respiratory rate
425:(1869–1939), an
351:The role of the
75:brain herniation
51:Cushing response
43:Cushing reaction
21:
2984:
2983:
2979:
2978:
2977:
2975:
2974:
2973:
2949:
2948:
2947:
2942:
2933:oxygen toxicity
2909:
2797:ventilation (V)
2785:
2781:pulmonary shunt
2759:
2750:peak flow meter
2670:
2588:
2495:
2490:
2460:
2455:
2414:Acoustic reflex
2397:
2351:Coronary reflex
2329:
2308:
2250:
2234:Patellar reflex
2197:
2170:Jaw jerk reflex
2146:
2141:
2111:
2098:
2082:
2066:
2035:
2029:Phalen maneuver
1989:
1973:
1969:Westphal's sign
1959:Chaddock reflex
1942:
1904:
1888:Cushing's triad
1869:
1819:
1801:
1792:
1762:
1750:
1749:
1740:
1739:
1727:
1705:
1696:
1677:
1670:
1653:
1649:
1638:
1634:
1618:
1617:
1609:
1605:
1574:
1570:
1559:
1552:
1539:
1535:
1528:
1514:
1510:
1503:
1489:
1485:
1477:
1475:
1473:
1455:
1451:
1444:
1422:
1418:
1411:
1397:
1393:
1356:
1352:
1341:
1337:
1306:
1302:
1265:
1261:
1237:10.1.1.507.1734
1220:
1216:
1187:(2–4): 125–31.
1176:
1169:
1138:
1134:
1113:(10): 3279–88.
1103:
1099:
1068:
1064:
1029:J Clin Neurosci
1025:
1012:
989:
976:
945:
920:
889:
874:
835:
831:
800:
783:
764:
753:
722:
718:
695:
688:
684:
667:
574:
566:Bernhard Naunyn
559:Friedrich Jolly
547:
527:Cushing's triad
502:
408:
389:Cushing's triad
386:
384:Cushing's triad
362:
252:
162:
94:
63:Cushing's triad
28:
23:
22:
15:
12:
11:
5:
2982:
2972:
2971:
2969:Medical triads
2966:
2961:
2944:
2943:
2941:
2940:
2935:
2930:
2929:
2928:
2917:
2915:
2911:
2910:
2908:
2907:
2897:
2892:
2887:
2882:
2879:chloride shift
2872:
2869:Haldane effect
2866:
2861:
2856:
2847:
2842:
2837:
2832:
2827:
2822:
2817:
2816:
2815:
2810:
2799:
2793:
2791:
2787:
2786:
2784:
2783:
2778:
2773:
2767:
2765:
2761:
2760:
2758:
2757:
2752:
2747:
2742:
2737:
2735:
2729:
2728:
2726:FEV1/FVC ratio
2723:
2718:
2716:
2712:
2711:
2706:
2701:
2696:
2691:
2686:
2680:
2678:
2672:
2671:
2669:
2668:
2667:
2666:
2656:
2655:
2654:
2649:
2641:chemoreceptors
2637:
2636:
2635:
2630:
2618:
2617:
2616:
2611:
2598:
2596:
2590:
2589:
2587:
2586:
2581:
2580:
2579:
2574:
2569:
2561:
2556:
2551:
2549:elastic recoil
2546:
2541:
2536:
2531:
2526:
2525:
2524:
2519:
2514:
2503:
2501:
2497:
2496:
2489:
2488:
2481:
2474:
2466:
2457:
2456:
2454:
2453:
2448:
2447:
2446:
2436:
2431:
2426:
2421:
2416:
2411:
2405:
2403:
2399:
2398:
2396:
2395:
2394:
2393:
2385:
2384:
2383:
2378:
2368:
2363:
2358:
2356:Cushing reflex
2353:
2348:
2343:
2337:
2335:
2334:Cardiovascular
2331:
2330:
2328:
2327:
2322:
2316:
2314:
2310:
2309:
2307:
2306:
2301:
2296:
2291:
2286:
2281:
2276:
2271:
2266:
2260:
2258:
2252:
2251:
2249:
2248:
2247:
2246:
2244:Plantar reflex
2241:
2236:
2228:
2227:
2226:
2224:Triceps reflex
2221:
2216:
2207:
2205:
2199:
2198:
2196:
2195:
2190:
2177:
2175:Corneal reflex
2172:
2167:
2162:
2156:
2154:
2148:
2147:
2140:
2139:
2132:
2125:
2117:
2108:
2107:
2104:
2103:
2100:
2099:
2097:
2096:
2090:
2088:
2084:
2083:
2081:
2080:
2074:
2072:
2068:
2067:
2065:
2064:
2059:
2054:
2049:
2043:
2041:
2037:
2036:
2034:
2033:
2032:
2031:
2026:
2014:
2012:Froment's sign
2008:
2006:
1999:
1995:
1994:
1991:
1990:
1988:
1987:
1981:
1979:
1975:
1974:
1972:
1971:
1966:
1961:
1956:
1954:Plantar reflex
1950:
1948:
1944:
1943:
1941:
1940:
1934:
1932:
1925:
1916:
1910:
1909:
1906:
1905:
1903:
1902:
1897:
1892:
1891:
1890:
1877:
1875:
1871:
1870:
1868:
1867:
1862:
1857:
1855:Myerson's sign
1852:
1850:Macewen's sign
1847:
1842:
1836:
1834:
1827:
1821:
1820:
1818:
1817:
1812:
1806:
1803:
1802:
1799:nervous system
1791:
1790:
1783:
1776:
1768:
1761:
1760:
1751:|journal=
1725:
1694:
1668:
1647:
1632:
1603:
1568:
1550:
1533:
1526:
1508:
1501:
1483:
1471:
1449:
1442:
1416:
1409:
1391:
1350:
1335:
1310:Am. J. Physiol
1300:
1259:
1214:
1181:Acta Neurochir
1167:
1148:(7): 1445–50.
1132:
1097:
1078:(6): 10C–13C.
1072:Am. J. Cardiol
1062:
1010:
993:Ann. Clin. Res
974:
918:
872:
829:
781:
751:
732:(6): 327–336.
716:
685:
683:
680:
679:
678:
673:
666:
663:
649:blood pressure
603:The nature of
586:blood pressure
578:Harvey Cushing
573:
570:
546:
543:
515:blood pressure
506:Leonard Hill's
501:
498:
478:blood pressure
450:Hugo Kronecker
415:Harvey Cushing
407:
404:
403:
402:
399:
396:
385:
382:
361:
358:
331:parietal cells
327:Cushing ulcers
304:cardiac output
251:
248:
190:rises in ICP.
161:
158:
154:blood pressure
127:to the brain (
113:pulse pressure
102:brain ischemia
93:
90:
86:Harvey Cushing
39:Cushing effect
31:Cushing reflex
26:
9:
6:
4:
3:
2:
2981:
2970:
2967:
2965:
2962:
2960:
2957:
2956:
2954:
2939:
2936:
2934:
2931:
2927:
2924:
2923:
2922:
2921:high altitude
2919:
2918:
2916:
2914:Insufficiency
2912:
2905:
2901:
2898:
2896:
2893:
2891:
2888:
2886:
2885:oxyhemoglobin
2883:
2880:
2876:
2873:
2870:
2867:
2865:
2862:
2860:
2857:
2855:
2851:
2848:
2846:
2843:
2841:
2838:
2836:
2833:
2831:
2828:
2826:
2823:
2821:
2818:
2814:
2811:
2809:
2806:
2805:
2803:
2800:
2798:
2795:
2794:
2792:
2788:
2782:
2779:
2777:
2774:
2772:
2769:
2768:
2766:
2762:
2756:
2753:
2751:
2748:
2746:
2743:
2741:
2738:
2736:
2734:
2731:
2730:
2727:
2724:
2722:
2719:
2717:
2714:
2713:
2710:
2707:
2705:
2702:
2700:
2697:
2695:
2692:
2690:
2687:
2685:
2682:
2681:
2679:
2677:
2673:
2665:
2662:
2661:
2660:
2657:
2653:
2650:
2648:
2645:
2644:
2643:
2642:
2638:
2634:
2631:
2629:
2626:
2625:
2624:
2623:
2619:
2615:
2612:
2610:
2607:
2606:
2605:
2604:
2600:
2599:
2597:
2595:
2591:
2585:
2582:
2578:
2575:
2573:
2570:
2568:
2565:
2564:
2562:
2560:
2557:
2555:
2554:hysteresivity
2552:
2550:
2547:
2545:
2542:
2540:
2537:
2535:
2532:
2530:
2527:
2523:
2520:
2518:
2515:
2513:
2510:
2509:
2508:
2505:
2504:
2502:
2498:
2494:
2487:
2482:
2480:
2475:
2473:
2468:
2467:
2464:
2452:
2449:
2445:
2442:
2441:
2440:
2437:
2435:
2432:
2430:
2427:
2425:
2422:
2420:
2417:
2415:
2412:
2410:
2407:
2406:
2404:
2400:
2392:
2389:
2388:
2386:
2382:
2379:
2377:
2374:
2373:
2372:
2369:
2367:
2364:
2362:
2361:Diving reflex
2359:
2357:
2354:
2352:
2349:
2347:
2344:
2342:
2339:
2338:
2336:
2332:
2326:
2323:
2321:
2318:
2317:
2315:
2311:
2305:
2302:
2300:
2297:
2295:
2292:
2290:
2287:
2285:
2282:
2280:
2277:
2275:
2272:
2270:
2267:
2265:
2262:
2261:
2259:
2257:
2253:
2245:
2242:
2240:
2237:
2235:
2232:
2231:
2229:
2225:
2222:
2220:
2217:
2215:
2214:Biceps reflex
2212:
2211:
2209:
2208:
2206:
2204:
2200:
2194:
2191:
2189:
2185:
2181:
2178:
2176:
2173:
2171:
2168:
2166:
2163:
2161:
2158:
2157:
2155:
2153:
2152:Cranial nerve
2149:
2145:
2138:
2133:
2131:
2126:
2124:
2119:
2118:
2115:
2095:
2094:Pain stimulus
2092:
2091:
2089:
2085:
2079:
2078:Beevor's sign
2076:
2075:
2073:
2069:
2063:
2060:
2058:
2055:
2053:
2052:Hoover's sign
2050:
2048:
2047:Gowers's sign
2045:
2044:
2042:
2038:
2030:
2027:
2025:
2022:
2021:
2020:
2019:
2015:
2013:
2010:
2009:
2007:
2003:
2000:
1996:
1986:
1983:
1982:
1980:
1976:
1970:
1967:
1965:
1962:
1960:
1957:
1955:
1952:
1951:
1949:
1945:
1939:
1936:
1935:
1933:
1929:
1926:
1924:
1920:
1917:
1915:
1911:
1901:
1898:
1896:
1893:
1889:
1886:
1885:
1884:
1883:
1879:
1878:
1876:
1872:
1866:
1863:
1861:
1858:
1856:
1853:
1851:
1848:
1846:
1845:Kernig's sign
1843:
1841:
1840:Battle's sign
1838:
1837:
1835:
1831:
1828:
1826:
1822:
1816:
1813:
1811:
1808:
1807:
1804:
1800:
1796:
1789:
1784:
1782:
1777:
1775:
1770:
1769:
1766:
1756:
1744:
1736:
1732:
1728:
1722:
1718:
1714:
1710:
1703:
1701:
1699:
1690:
1686:
1682:
1675:
1673:
1664:
1660:
1659:
1651:
1643:
1636:
1628:
1622:
1614:
1607:
1599:
1595:
1591:
1587:
1583:
1579:
1572:
1564:
1557:
1555:
1546:
1545:
1537:
1529:
1523:
1519:
1512:
1504:
1498:
1494:
1487:
1474:
1472:9781455770052
1468:
1464:
1460:
1453:
1445:
1443:9780397511600
1439:
1435:
1430:
1429:
1420:
1412:
1406:
1402:
1395:
1387:
1383:
1378:
1373:
1369:
1365:
1361:
1354:
1346:
1339:
1331:
1327:
1323:
1319:
1315:
1311:
1304:
1296:
1292:
1287:
1282:
1279:(3): 245–52.
1278:
1274:
1270:
1263:
1255:
1251:
1247:
1243:
1238:
1233:
1229:
1225:
1218:
1210:
1206:
1202:
1198:
1194:
1190:
1186:
1182:
1174:
1172:
1163:
1159:
1155:
1151:
1147:
1143:
1136:
1128:
1124:
1120:
1116:
1112:
1108:
1101:
1093:
1089:
1085:
1081:
1077:
1073:
1066:
1058:
1054:
1050:
1046:
1042:
1038:
1034:
1030:
1023:
1021:
1019:
1017:
1015:
1006:
1002:
998:
994:
987:
985:
983:
981:
979:
970:
966:
962:
958:
955:(6): 543–50.
954:
950:
943:
941:
939:
937:
935:
933:
931:
929:
927:
925:
923:
914:
910:
906:
902:
899:(6): 454–61.
898:
894:
887:
885:
883:
881:
879:
877:
868:
864:
860:
856:
852:
848:
844:
840:
833:
825:
821:
817:
813:
809:
805:
798:
796:
794:
792:
790:
788:
786:
777:
773:
769:
762:
760:
758:
756:
747:
743:
739:
735:
731:
727:
720:
712:
708:
704:
700:
693:
691:
686:
677:
674:
672:
669:
668:
662:
659:
657:
652:
650:
644:
642:
638:
634:
630:
625:
623:
619:
615:
611:
606:
601:
599:
595:
591:
587:
583:
579:
569:
567:
562:
560:
556:
552:
542:
538:
536:
532:
528:
524:
520:
516:
511:
507:
497:
495:
491:
487:
483:
479:
475:
471:
467:
463:
459:
455:
451:
447:
443:
439:
435:
431:
428:
424:
416:
412:
400:
397:
394:
393:
392:
390:
381:
379:
375:
371:
367:
357:
354:
349:
347:
343:
338:
336:
332:
328:
324:
320:
316:
315:baroreceptors
311:
309:
305:
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297:
293:
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276:
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118:
114:
110:
103:
98:
89:
87:
84:
80:
76:
72:
68:
64:
60:
56:
55:Cushing's Law
52:
48:
44:
40:
36:
32:
19:
2825:gas exchange
2790:Interactions
2715:calculations
2676:Lung volumes
2639:
2620:
2601:
2572:constriction
2534:respirometer
2387:Respiratory
2355:
2024:Tinel's sign
2016:
1880:
1708:
1680:
1657:
1650:
1641:
1635:
1612:
1606:
1584:(5): 750–7.
1581:
1578:Neurosurgery
1577:
1571:
1562:
1543:
1536:
1517:
1511:
1492:
1486:
1476:, retrieved
1462:
1452:
1427:
1419:
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1367:
1363:
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1344:
1338:
1313:
1309:
1303:
1276:
1272:
1262:
1230:(6): 791–9.
1227:
1224:Br J Anaesth
1223:
1217:
1184:
1180:
1145:
1141:
1135:
1110:
1106:
1100:
1075:
1071:
1065:
1035:(3): 223–8.
1032:
1028:
996:
992:
952:
948:
896:
892:
845:(2): 131–7.
842:
838:
832:
807:
804:Neurosurgery
803:
775:
771:
729:
725:
719:
702:
698:
660:
653:
645:
626:
602:
598:pathogenesis
582:pathogenesis
575:
563:
548:
539:
503:
470:Angelo Mosso
454:Kroenecker's
430:neurosurgeon
420:
388:
387:
366:brain tissue
363:
350:
339:
312:
300:contractions
296:hypertension
277:
253:
244:
221:, including
211:
192:
171:
137:
106:
83:neurosurgeon
54:
50:
46:
42:
38:
34:
30:
29:
2864:Bohr effect
2764:Circulation
2500:Respiration
2429:Optokinetic
2269:Gastrocolic
1931:Combination
1865:Hirano body
1860:Stroop test
1370:(1): 8–17.
893:Surg Neurol
637:anesthetics
629:respiration
555:Henri Duret
438:Switzerland
398:Bradycardia
370:homeostasis
323:vagus nerve
319:aortic arch
313:Meanwhile,
308:tachycardia
223:concussions
146:Mayer waves
144:present as
141:ventilation
121:bradycardia
79:epinephrine
71:head injury
67:bradycardia
2953:Categories
2926:death zone
2845:hemoglobin
2740:spirometry
2699:dead space
2652:peripheral
2577:dilatation
2563:bronchial
2544:compliance
2517:exhalation
2512:inhalation
2371:Baroreflex
2299:Tonic neck
1478:2019-11-10
682:References
641:anesthesia
594:brain stem
519:pulse rate
474:Kroenecker
378:baroreflex
335:infarction
265:arterioles
239:ventricles
203:autoimmune
133:arterioles
125:blood flow
117:heart rate
92:Definition
2802:Perfusion
2304:Parachute
1753:ignored (
1743:cite book
1621:cite book
1364:Circ. Res
1232:CiteSeerX
705:(8): 42.
605:receptors
342:brainstem
250:Mechanism
88:in 1901.
2964:Reflexes
2813:V/Q scan
2419:H-reflex
2289:Stepping
2144:Reflexes
1923:Reflexes
1735:16463859
1254:15805143
1127:19100373
1057:43225467
1049:18182296
859:21386665
824:17143247
778:: 290–2.
711:12224233
665:See also
510:arterial
427:American
360:Function
337:occurs.
292:arteries
282:and the
273:ischemia
269:cerebrum
207:rejected
129:ischemia
109:systolic
2938:hypoxia
2859:2,3-BPG
2647:central
2622:medulla
2594:Control
2294:Sucking
2284:Rooting
2087:General
1689:1102170
1598:1584389
1386:4402639
1330:2887122
1295:9102186
1209:1449385
1201:3962742
1162:9227698
1092:2643847
1005:3813470
969:2176941
913:3375974
867:6025444
746:3435736
490:English
406:History
372:in the
317:in the
227:hypoxia
188:chronic
2507:breath
2264:Galant
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590:anemia
521:, and
486:German
235:stroke
233:, and
231:tumors
219:trauma
49:, the
45:, the
41:, the
37:, the
2402:Other
2274:Grasp
2071:Torso
1998:Other
1874:Other
1665:–193.
1205:S2CID
1053:S2CID
863:S2CID
656:fetal
633:apnea
531:Mosso
468:with
466:Italy
462:Turin
374:brain
346:apnea
184:acute
53:, or
2904:DLCO
2804:(Q)
2603:pons
2279:Moro
2230:Leg
2210:Arm
2040:Legs
2005:Arms
1978:Arms
1947:Legs
1833:Head
1755:help
1731:PMID
1721:ISBN
1685:PMID
1627:link
1594:PMID
1522:ISBN
1497:ISBN
1467:ISBN
1438:ISBN
1405:ISBN
1382:PMID
1326:PMID
1291:PMID
1250:PMID
1197:PMID
1158:PMID
1123:PMID
1088:PMID
1045:PMID
1001:PMID
965:PMID
909:PMID
855:PMID
820:PMID
742:PMID
707:PMID
616:and
488:and
480:and
458:Bern
434:Bern
302:and
186:and
111:and
2709:PEF
2689:FRC
1713:doi
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1586:doi
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1372:doi
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