Increased ICP and Cushings triad

[love-d-OR]

Hey guys,

We rarely use ICP monitors in my unit, because we have a neuro ICU and they get all neuro pt's. I recently had a pt who was suspected of having cerebral edema (results from ct scan not available on date in question), but his pupils were equal and reactive and there was no evidence of increased ICP. Anyway, my question is this: Have you ever had a patient with Cushings triad, without the classic early signs of increased ICP?

[hepatocyte62]

Depends what you mean by 'early signs'. If you mean a decreased GCS the answer is definitely no, a patient is not going to have a GCS above 3 (I'm not sure if they'd still be extending but I'm guesing not) and also manifest cushings triad as this is a sign that the brain stem is herniating. Dilated and unreactive pupils are a late sign of increased ICP and impending herniation; cushings triad is cardiovascular manifestation of the process of herniation it would be impossible for this to happen without other signs of increased ICP.

If you don't have a bolt in and the patient is sedated you only have the pupils to go on, but as far as I'm aware these should blow before you get cushings triad.

To make absolutely sure I will ask one of our neurosurgeons tomorrow.

[love-d-OR]

The patient is doing well, as of last I saw him. Vitals signs were looking very good, still sedated, but much better than the previous day. Also, we had a CT scan done that day that came back negative. Thank you for answering.