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Cushing’S Reflex And Bradycardic Arrest In Cryptococcal Meningitis, Scott Briggs, Trent Malcolm

Rowan-Virtua Research Day

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 …