Date of Presentation

5-6-2021 12:00 AM

College

School of Osteopathic Medicine

Poster Abstract

Cushing’s reflex is a physiologic response to maintain cerebral perfusion pressure with elevated systolic blood pressure, widened pulse pressure, and bradycardia occurring in the setting of elevated intracranial pressure (ICP). The proposed mechanisms for reflexive bradycardia include ischemia to medullary brain tissue and compression of the intracranial segment of the vagus nerve leading to parasympathetic activation. (1) In acutely elevated ICP, bradycardia is a late finding of worsening intracranial pathology suggestive of impending herniation and cardiovascular collapse.

Cryptococcal meningitis has been identified by Infectious Disease Society of America for its association with elevated ICP. (2) Variety of pathogenic mechanisms occurring in meningitis predispose to ICP including toxin mediated injuries and inflammatory host response leading to cytotoxic, vasogenic and interstitial edema with hydrocephalus and venous congestion. (3) Previous studies of cryptococcal meningitis have shown a mortality benefit from therapeutic lumbar puncture (LP) with CSF removal to reduce ICP. (4)

Keywords

Cushing's Reflex, bradycardia, Cryptococcal meningitis, Cerebrovascular Circulation

Disciplines

Bacterial Infections and Mycoses | Cardiovascular Diseases | Internal Medicine | Medicine and Health Sciences | Neurology

Document Type

Poster

COinS
 
May 6th, 12:00 AM

Cushing’s Reflex and Bradycardic Arrest in Cryptococcal Meningitis

Cushing’s reflex is a physiologic response to maintain cerebral perfusion pressure with elevated systolic blood pressure, widened pulse pressure, and bradycardia occurring in the setting of elevated intracranial pressure (ICP). The proposed mechanisms for reflexive bradycardia include ischemia to medullary brain tissue and compression of the intracranial segment of the vagus nerve leading to parasympathetic activation. (1) In acutely elevated ICP, bradycardia is a late finding of worsening intracranial pathology suggestive of impending herniation and cardiovascular collapse.

Cryptococcal meningitis has been identified by Infectious Disease Society of America for its association with elevated ICP. (2) Variety of pathogenic mechanisms occurring in meningitis predispose to ICP including toxin mediated injuries and inflammatory host response leading to cytotoxic, vasogenic and interstitial edema with hydrocephalus and venous congestion. (3) Previous studies of cryptococcal meningitis have shown a mortality benefit from therapeutic lumbar puncture (LP) with CSF removal to reduce ICP. (4)

 

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