Nov 16, 2013

A dangerous Cushing response in a child: neurogenic heart damage

The American Journal of Emergency Medicine
Francesco RuggieriLuigi Beretta


Cushing response, which acts to preserve cerebral blood flow by inducing arterial hypertension, could induce neurogenic heart damage through hyperactivation of autonomic nervous system. Most of clinical reports describe neurogenic heart damage as a self-limiting condition clinically characterized by electrocardiographic abnormalities in the setting of an acute neurologic insult. Here we describe a case of life-threatening cardiac dysfunction immediately after a massive intracerebral hemorrhage in a healthy 7-year-old child. The low probability of ischemic heart disease, the poor increase of cardiac necrosis markers, the localization of regional wall motion abnormalities that are not typical for coronary artery disease, and reversibility after brain surgical decompression are consistent all with neurogenic heart damage. Acute decrease of brain oxygen delivery caused by cardiac dysfunction worsens secondary brain injury in the setting of an acute neurologic insult. Thus, Cushing response, which is a physiological mechanism of cerebral protection, could become a double-edged sword when massive sympathetic activation makes the myocardium stunned.

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Mentioned in this Paper

Autonomic Nervous System Disorders
Establishment and Maintenance of Localization
Entire Autonomic Nervous System
Cerebral Blood Flow Imaging
Pulmonary Arterial Hypertension
Coronary Artery Disease
Myocardial Ischemia

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