Cushing's triad

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'''Cushing's triad''' is the triad of hypertension, bradycardia,^[1] and widening pulse pressure (an increase in the difference between systolic and diastolic pressure over time) in patients with head injuries. It is often accompanied by respiratory abnormalities, including Cheyne-Stokes respiration, hypoventilation, and central neurogenic hyperventilation, although these are not part of the triad proper. It is named after Harvey Williams Cushing (1869-1939), the American neurosurgeon who first described this combination of signs.

Identification of the combination of these signs is critically important, especially in the setting of emergency medicine because it is a sign of increasing intracranial pressure. Many times it is a sign of herniation of the brain. A patient with these signs will usually require urgent life-saving surgery which may include drilling a burr hole into the head to reduce intracranial pressure.

This may be a sign of impending tonsillar herniation, that is herniation of the brain stem through the foramen magnum (the opening in the base of the skull that the spinal column passes through) which is a sign of impending brain death.