A dangerous Cushing response in a Child

Neurogenic heart damage

Francesco Ruggieri, Maria Rosa Calvi, Luigi Beretta

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

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.

Original languageEnglish
Pages (from-to)393.e1-393.e3
JournalAmerican Journal of Emergency Medicine
Volume32
Issue number4
DOIs
Publication statusPublished - 2014

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Nervous System
Cerebrovascular Circulation
Myocardial Stunning
Surgical Decompression
Autonomic Nervous System
Cerebral Hemorrhage
Brain
Brain Injuries
Myocardial Ischemia
Coronary Artery Disease
Necrosis
Oxygen
Hypertension

ASJC Scopus subject areas

  • Emergency Medicine

Cite this

A dangerous Cushing response in a Child : Neurogenic heart damage. / Ruggieri, Francesco; Calvi, Maria Rosa; Beretta, Luigi.

In: American Journal of Emergency Medicine, Vol. 32, No. 4, 2014, p. 393.e1-393.e3.

Research output: Contribution to journalArticle

Ruggieri, Francesco ; Calvi, Maria Rosa ; Beretta, Luigi. / A dangerous Cushing response in a Child : Neurogenic heart damage. In: American Journal of Emergency Medicine. 2014 ; Vol. 32, No. 4. pp. 393.e1-393.e3.
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