The Cushing Response: A case for a review of its role as a physiological reflex

Despite a century of work on the subject, controversy still exists as to the physiological relevance of the Cushing response (CR), a state of raised systemic blood pressure and bradycardia associated with raised intracranial pressure. The alternative that has been proposed to the classical belief of pre-terminal brainstem damage is of a baroreflex that attempts to maintain cerebral perfusion in response to situations of extreme elevations in intracranial pressure or brainstem ischemia. We report a patient with spontaneous subarachnoid haemorrhage who demonstrated CR, which was later seen to self-abort with an eventual good outcome. We review the existing literature and propose that our clinical case may provide further support for a physiological role of CR.