Talk:Cushing reflex

Merger Proposal

These two pages clearly refer to the same thing. Discuss.

I don't know which page should be the main page or have the time to complete the merger myself :-)

Thanks! Captain n00dle ^T/_C 22:15, 10 June 2009 (UTC)

p.s. A redirect should exist! I think both terms are used! Captain n00dle ^T/_C 22:19, 10 June 2009 (UTC)

Cushion's Reflex explains the pathological response that gives birth to the triad. They are not the same, one begets the other.

True, although the information would be much more helpful together. —Preceding unsigned comment added by 24.250.10.195 (talk) 04:32, 8 November 2009 (UTC)

I support above proposal of redirection. —Preceding unsigned comment added by 119.30.36.50 (talk) 02:51, 20 January 2010 (UTC)

It's true that the Cushing triad is different, but I don't think that's the proposed merger. The proposal is for Cushing reaction and Cushing reflex, which are synonymous. I'll do it: Cushing reflex will be the main article, Cushing reaction a redirect. - Draeco (talk) 17:50, 20 May 2010 (UTC)

The two pages don't really refer to the same thing, the Cushing's reflex refers to the physiology which gives rise to Cushing's triad. The triad itself is a list of symptoms. The page for Cushing's triad should probably be inserted into that for Cushing's reflex under a 'signs and symptoms' section, or even 'diagnosis' as a diagnostic triad. That being said, Cushing's reflex itself is not a condition, rather the result of raised intracranial pressure, so maybe they could both be inserted into the page for raised intracranial pressure? 203.161.102.145 (talk) 14:01, 29 September 2011 (UTC)

Cushing Reflex article edits

Hello,

I am a student at Boston College, and as part of a Neuroscience class project, a group of classmates and I have the been given task of improving the quality of the Cushing Reflex article page. Hopefully, our work on the page can significantly better the state of this article. I wanted to mention it so people are aware of what is going on when edits are beginning to be made to the page. I am more than open to anyone's thoughts and advice. Thank you. — Preceding unsigned comment added by Sean Dikdan (talk • contribs) 04:52, 23 March 2011 (UTC)

Some comments

• On sources: it is clear that editors have made an important effort to find sources, which in general has been really succesful. However taking a closer look to sources they seem a bit indiscriminate: there are many great sources (secondary recent reviews in scientific journals), but they are mixed with other primary or old sources. Maybe it would be a good idea to try to substitute some of these references with content covered in the best references of the article.

• Similarly sentences like "In a 71 year old male case study, it was concluded that the physiological conditions brought on by ischemia alone caused a Cushing reflex response" are best to be avoided: either that case was later commented in a secondary source (and then we should re-express it) or it is probably giving too much weight to it and would be better eliminate it.

• Organization: the article could be better organized in my opinion: history sections tend to go at the end in wikipedia. Additionally the signs and symptoms section would better fit just at the beginning of the article, after the lead, since it is where it is explained what the reflex consists in; the title "phisiological significance " could be simplified to function.

• I am making some comments for all students at User talk:NeuroJoe/BI481 Spring 2011. Take a look at them since many are applyable here. For example: in see also section there should not be articles that have already appeared and linked in the article: Policy is that when a link already appears in the article it should not appear also in the see also section. In this sense "see also" is the place for connected links not mentioned in text.

More comments as I have time.--Garrondo (talk) 14:26, 25 March 2011 (UTC)

• The article is greatly improving. However a Wiki-manner tip: It is always good to response to other's comments. If you had answer to my comments above I would have come back earlier. I always say that editing brings editing, and it makes more enjoyable or time in Wikipedia. :-)

• It would be a great moment to add some images. Proposals: an image of ischemia? of subaracnoid hemorraghe? of Harvey Cushing? Other?

• The lead should be the most accessible part of an article. Even if they are linked I would give a short explanation of the most technical terms. In this case I would explain bradykardia (a short line in brackets should be enough). I would also link some more terms in the lead as "head injury" , "nervous system" or "intravenous".

• On the other hand most people know what is American, it is a clear example of overlinking. Better to delink.

• While the most important place for fixes above is the lead, similar edits would be helpful all over the article.

Bests. I'll try to be back--Garrondo (talk) 06:43, 28 March 2011 (UTC)

• Use of sources has improved. Nevertheless there are some primary sources that should be better eliminated: Ogilvy (1987) and Woodman (1987) are two old primary refs that are only used once: The info they support most probably appears in a secondary source. Wan (2008) seems more complicated: it is used 4 times while it is only a case report but quite recent. Can some of it uses be substituted with a secondary source?--Garrondo (talk) 06:55, 28 March 2011 (UTC)

More minor comments:

• There should not be internal links in the references section: "kidney transplantation" in ref 18 should be delinked.--Garrondo (talk) 06:36, 30 March 2011 (UTC)
• Only link between Cushing ulcer and Cushing triad is the eponym. I do not think it merits a place in the see also section. I would rather eliminate the section.--Garrondo (talk) 06:36, 30 March 2011 (UTC)
• No Caps on titles. Instead of "Motorcycle Accident and Neurological Profile" should be "Motorcycle accident and neurological profile" and so on.--Garrondo (talk) 06:52, 30 March 2011 (UTC)
• Also as a minor comment: inline citations in wikipedia go after and not before the full stop of the sentence, there is no space between the full stop and the ref, and after the ref goes a space before the next sentence. A correct example would be "Hello world, I feel great today.[1] Today is sunny.": I see many errors in the research directions and other researchers sections.--Garrondo (talk) 06:57, 30 March 2011 (UTC)
• Similarly check punctuation all over the article there are several missing commas and full stops, usually before or after a reference.--Garrondo (talk) 06:57, 30 March 2011 (UTC)
• Words should only be linked once: the first time they appear in the body of the article (the lead and images are an exception to this in the sense that words that are linked in the body of the article should also be linked in the caption of an image or the lead. --Garrondo (talk) 07:00, 30 March 2011 (UTC)

Thank you

Thank you for the comments! My group and I have not had the chance to all meet since revising the article, but I have been trying to make some of the changes over the course of the week. When we do meet, we are going to go through all of the above bullet points. You have been extremely helpful, and I am learning a great deal about the Wikipedia community.

Please keep the comments coming. Sean J. Dikdan (talk) 04:00, 29 April 2011 (UTC)

I have been going through the comments that you have made and I wanted to say thank you. The article would not have been where it is right now without your suggestions. Thank you. As for the remaining comments, I think that I have addressed some of your concerns. I left the "See Also" section of the article because I feel that there are some articles that should be related to this one. I only have Traumatic Head Injury there right now, but I want to leave it open so that others may add articles there as well. We have done some punctuation and grammar sweeps, but we plan on going through it again. Thank you! Please feel free to add any more comments. Sean J. Dikdan (talk) 04:00, 29 April 2011 (UTC)

P.S. As for picture, we were thinking of posting Cushing's experimental design for testing the Cushing Reflex in his original paper. —Preceding unsigned comment added by 136.167.121.132 (talk) 23:05, 29 March 2011 (UTC)

Image from the original article is a great idea. In this article there could be 4 images more or less (one by section) so you can also add some of the above. Right now I do not think I will be making more comments in a systematic way over the different articles, but if you feel you have addressed comments above leave me a note at my talk page and I will come back for further comments. This article has improved a great deal and you should be proud of it. Bests.--Garrondo (talk) 06:14, 30 March 2011 (UTC)

Lay audience

As stated above, WP is aimed to a general audience. Since most people writing science articles have higher education and some terms are hard to explain this can be a great challenge. I have edited the signs and symptoms section as an example of what can be done to make access to the article easier. I try to use non technical terms when they correctly substitute a technical one (for example "inside the skull" instead of "intracranial") and when that is not possible in addition to the wikilink the first time I use an important term I try to explain it with a short line (this can usually be easily done by going to the term article and copy-editing a line from its lead). For example the first time instead of simply saying These physiological symptoms can be indicative of cerebral ischemia I would say These symptoms can be indicative of insufficient blood flow to the brain (ischemia). --Garrondo (talk) 06:47, 30 March 2011 (UTC)

I am going to copy here the before and after my copy edit as an example. I believe the article would benefit from similar copy edits all through it.

Before:

The Cushing reflex is characterized by increased intracranial pressure. Its classical symptoms are an increase in systolic and pulse pressure, bradycardia, and irregular respiration. These physiological symptoms can be indicative of cerebral ischemia as well as compression of arterioles.

In response to rising ICP, respiratory rate increases. The increase in ventilation is exhibited as an increase in rate rather than depth of ventilation, so the Cushing reflex is often associated with slow, irregular breathing. Mayer waves are also a sign of the Cushing reflex, as can be observed from blood pressure traces or ECGs. Mayer waves are the symptoms of a physiological response to falling blood flow, responding with an increase in blood pressure.

After:

The Cushing reflex is characterized by increased pressure inside the skull. Its classical symptoms are an increase in systolic and pulse pressure, reduction of the heart rate (bradycardia), and irregular respiration. These symptoms can be indicative of insufficient blood flow to the brain (ischemia) as well as compression of arterioles.

In response to rising ICP, respiratory rate increases. The increase in ventilation is exhibited as an increase in rate rather than depth of ventilation, so the Cushing reflex is often associated with slow, irregular breathing. Mayer waves, which are waves in arterial blood pressure that can be seen in an electrocardiograph ECG register or blood pressure traces. Mayer waves are the symptoms of a physiological response to falling blood flow, responding with an increase in blood pressure.

• See also that "ventilation" now links to "ventilation (physiology)" instead than to the disambiguation page "ventilation". It is usually a good idea to check internal links so they actually link to where you want.--Garrondo (talk) 07:05, 30 March 2011 (UTC)

• We made a big push to properly link certain words and simply all the sections of the article. Our group also changed the signs and symptoms section directly, as you mentioned above. Phil J. (talk) 04:04, 29 April 2011 (UTC)

References

BI481 Peer Reviews

For the sake of organization, I thought it may be easiest for everyone to post peer review comments under one heading. That way, my group and I can respond to them in a ordered fashion. Thank you! Sean J. Dikdan (talk) 07:00, 7 April 2011 (UTC)

Very well-rounded article; I was able to grasp a good understanding of your topic from your explanations. Here are a few suggestions that you might find helpful. First, I think it may improve ease of reading if an acronym used for the first time in each section is defined. For example, in the second sentence of the Mechanism section, ICP can be introduced as "intracranial pressure (ICP)" so the reader doesn't have to scroll back up to find out what ICP stands for. Second, I think the last two sentences of the Signs and Symptoms section regarding Mayer waves should be edited and possibly combined to correct the fragment issue as well as improve the flow of the sentences. For instance, you might write: "Mayer waves, which are waves in arterial blood pressure that can be seen in electrocardiograph ECG registers or blood pressure traces, are symptoms of blood pressure increase in response to falling blood flow." Third, in the Causes section, brain plateau waves are mentioned; it might be helpful if brain plateau waves and its significance in relation to ICP increase can be briefly explained. I really enjoyed reading about the actual history of the Cushing Reflex, great job! C.chi.han (talk) 23:47, 7 April 2011 (UTC)

• Thanks for the helpful comments. As you suggested, I made sure to define every acronym when it appeared first in every section. I can see how many people would be confused by the amount of abbreviations and medical terms within the article. I also reworded the last two sentences in the signs and symptoms section, as they seemed a little bit abrupt. Finally, I tried to clarify how brain plateau waves relate to ICP as best I could, given the medical articles available. I really appreciate the comments! Phil J. (talk) 03:03, 26 April 2011 (UTC)

• After reviewing the Signs and Symptoms a second time, I saw your point about the phrasing of the section regarding Mayer waves. Thank you for your suggestion. I restructured the last two sentences so that it could make more sense and so there would be no confusion as to what Mayer waves are. Thanks for your input! Cepedac (talk) 02:53, 27 April 2011 (UTC)

It seems to be a good article so far, but I have a few suggestions. The whole “Mechanism” section of the article is written in a way that I feel most people who don’t have strong scientific vocabulary would have trouble understanding. Perhaps you could either describe the mechanisms in way that would be easier to understand or explain some of the more esoteric terms you use to describe your topic. Another problem I found was in the Clinical Importance section. The first sentence, “One of the more prominent warning signs of the CR is that patient death will likely occur, sooner rather than later,” seems to be worded a bit awkwardly. Also in that same section, the sentence “Unfortunately, death may be inevitable if the cause of a CR and ICP is unknown” seems to be redundant and can probably be removed. Oconneia (talk) 20:20, 7 April 2011 (UTC)

• I agree that my initial Mechanism section was far too scientific for a general Wikipedia audience to understand. As a result, I tried to simplify it as best I could, explaining relevant medical terms when necessary. I also reworded the first 2-3 sentences in the clinical importance section. Finally, I removed the sentence beginning with "Unfortunately," as it was pretty redundant like you said. Thanks for the comments! Phil J. (talk) 04:01, 26 April 2011 (UTC)

Just to add a few more comments to what C.chi.han said. The introduction is very good information-wise, but I think some sentence variation could make help it flow a little better. For example, the first sentence may be a little more clear if you said, "The Cushing reflex (also referred to as the vasopressor response, the Cushing effect, the Cushing reaction, the Cushing phenomenon, the Cushing response, or Cushing's Law) is a physiological nervous system response to increased intracranial pressure (ICP) that includes increased pulse pressure, irregular breathing, and a reduction of the heart rate." Although I'm not entirely clear if the reflex itself is Cushing's Triad or if the reflex causes the triad. It would also be helpful to explain why the Cushing reflex occurs (e.g. an attempt to maintain homeostasis in the brain after an abnormal rise in intracranial pressure). The Mechanism section sounds a little choppy, as many sentences begin with "This..." I think more sentence variation here as well will improve the readibility. I also wasn't exactly sure what bradycardia was. That might be a good hyperlink. The Causes section was well-written, although some parts might be a little confusing with science terms. For example: "Induced subarachnoid hemorrhage studies on cats via injection of autologous blood into the cisterna magna of the brain confirmed that ICP causes mechanical distortion of the medulla, and is followed by sympathetic nervous system over activity." Also, as C.chi.han mentioned, there were a few occasions when I wasn't sure what certain acronyms stood for. Just be sure that the last reference to the full phrase isn't too far away. I hope some of these comments are helpful!

Chouda (talk) 00:49, 8 April 2011 (UTC)

• Thanks Chouda. My group and I recently reworded the introduction to make it flow better, using your parenthetical phrase in the first sentence. As for the purpose of the reflex, it has already been described in the function section of the article. As I told Oconneia, I reworded and simplified the mechanism section to make it more understandable for the general Wikipedia audience. Finally, I made sure to write out any acronyms that appear first in every section, not for just the entire article. As for the causes section, I made sure to simplify some of the sentence structure, especially for the one sentence you brought up. Phil J. (talk) 16:37, 26 April 2011 (UTC)

This article was clearly and concisely written. It is easy to follow and understand. The setup is very well done, with good usage of heading and subheadings. I would consider taking a look at the division between the mechanism and function paragraphs as there seems to be some overlap. The function section also needs some editing as it contains a series of abbreviations with no indication of what they mean. Using previous knowledge one could conclude that CR stands for Cushing’s Reflex but it is unclear what CBP and CBF stand for. In the Signs and symptoms section in the sentences about Meyer waves I believe the “or” is meant to be an “on” in order for that sentence to make sense. The first sentence of the Clinical Importance section is also unclear; currently I am interpreting it to say that death is a warning sign of CR. Also, the last paragraph of that section begins by citing paper authors, while there is nothing wrong with this it just feels a little odd, as it is the first usage of such technique. The History section is a nice touch that few articles have expanded so well. It is nice to see that it was given some attention rather than it being purely an afterthought. Overall it is a very good article.HRockwell (talk —Preceding undated comment added 13:31, 8 April 2011 (UTC).

• For the sake of consistence and clarity, all instances of CR have been changed to Cushing reflex, and the acronyms have either been explained or removed. The sentence structure in Signs and Symptoms/Clinical Importance has also been adjusted to make more sense. Thank you for your comments. Sean J. Dikdan (talk) 03:20, 29 April 2011 (UTC)

• We got rid of all CR (Cushing Reflex) abbreviations and made sure to spell out all the abbreviations the first time they appear in every section of the article. As said in my response to Oconneia, I reworded the first two sentences of the clinical importance section. I believe that there is little overlap in the mechanism and function sections. You may have been referring to some overlap in the mechanism and causes sections. I think that repeating some of the mechanism of the reflex in the causes section may make it easier for audiences to read, as it it not very well understood and difficult to grasp. Phil J. (talk) 03:21, 29 April 2011 (UTC)

Hey guys, you did an excellent job on this wiki article. It was extremely well written throughout the article and you did a great deal of research because you have a lot of good content. You also found an abundance of research papers which allowed you to analyze many different aspects of Cushing Reflex. A few constructive critiques that I think would enhance the paper include slight expansion on the introduction. Although it explains what Cushing Reflex is, I think you should go a bit deeper to allow to reader to know more about the topic before he/she starts reading the whole article to find the information. Also the history section provides a good overview but i think there is room for expansion here also with regards to experiments and results as well as the other researchers subsection. In addition, I think a picture would liven up the content on the page and add further understanding of the topic. Overall I think the article flowed very well. Good work! mastroin (talk) 2:14, 8 April 2011 (UTC)

• I may add a few lines from the Causes or Mechanisms section, but overall I really want the introduction to briefly introduce the reader to the subject without overloading them with too much detail that can be found elsewhere in the article. If there is something that you think specifically should be in the intro that is missing, I would greatly appreciate your thoughts. I agree with you completely about the picture. Harvey Cushing as been included to the section. I tried to keep the "Experimental setup and results" simple and understandable without including the complex steps of his experiments. What specifically would you look to have added? Furthermore, since the article focuses on Cushing reflex, I didn't want to go into the work of other researchers. I feel that this may be irrelevant to the topic and seem like more of a tangent thought. Thank you very much for your comments! Sean J. Dikdan (talk) 03:39, 29 April 2011 (UTC)

Very interesting article! One part I was just a little confused on was the second paragraph under “Signs and Symptoms” where effects on respiratory rate are explained, but this may be just an issue with wording. If there is a characteristic increase of rate of ventilation associated with Cushing’s Reflex, why would Cushing’s Reflex exhibit slow, irregular breathing? I would just naturally expect fast breathing if ventilation rate increases, so maybe you could just clarify that a little bit! Also, I especially liked the “Clinical Importance” section of your article, but the introductory sentence was a little strange. Maybe just start off with your second sentence? Finally, the history section was interesting, but I don’t think it is necessary to mention the controversy of plagiarism. Maybe just mention that some research regarding the Cushing Reflex has come from Bernhard Naunyn as well! Great article overall! Wilsonga (talk) 2:35, 8 April 2011 (UTC)

• Thanks for the help. As with Oconneia, I reworded the first two sentences of the clinical importance section and changed the introduction's wording. I believe that without mention of plagiarism, the account of the history would not be complete. Just to let you know, we moved this phrase to the "other researchers" section. The irregular breathing associated with the Cushing Reflex is more fully explained in the mechanism section, whereby distortion and/or increased pressure on the brainstem alters its homeostasis. This often results in irregular respiratory pattern and/or apnea since the brainstem controls involuntary breathing. The increased rate of ventilation is associated with tachycardia whereas slowed irregular breathing is associated with apnea and/or bradycardia. Phil J. (talk) 03:48, 29 April 2011 (UTC)

In addition to all the comments made, I would just like to point out that in the mechanism section it maybe helpful to include a concept map tying the different aspects of the mechanism together (maybe something you could draw up yourself using CMap tools). Although this isn’t usually typical of Wikipedia articles, it should prove to be helpful for readers. Also the use of ‘et al’ may be confusing to some readers who are unfamiliar with scientific literature, it may be better to just say: research conducted by such and such. Other than these minor comments, I think you guys did a terrific job with collecting the information and with the writing of this article. It may also help to add information pertaining to what drugs are usually used in a clinical setting to counteract the high BP and HR, you could include this in the ‘clinical importance’ section or start a new one altogether. Cheers! (Luhizi (talk) 18:55, 8 April 2011 (UTC))

• Thank you for your comments! Though the idea of a concept map is a difficult one to see through for this project, I was able to dress the other minor comments that you made. I agree, for readers who are not familiar with scientific literature 'et al' might be confusing, so that was changed in the Research Directions section. Thanks! Cepedac (talk) 02:53, 27 April 2011 (UTC)

This article is VERY well researched. I can tell that you guys spent a lot of time getting primary sources that, hopefully, are credible. I also felt as if the information you presented was well structured. I also wanted you to be aware of the Manual of Style for medicine-related articles. It might be advantageous to you to look over the basic structure / form of an article about medical disease, as wiki tends to like pages in a similar realm have a continuity to them. If there are any sections that wiki suggest you include in your disease-related article it might be a helpful tool for you to find a new angle to present different / important information. Regarding some of the information you presented, while it seemed to be written with a neutral tone and in correct grammar with correct spelling (as far as i could tell, I am not the best speller), it also came off as quite dense and a bit hard to follow. I felt myself needing to constantly click the links (there were a couple of times, like with the term ICP, where it was linked in some places and not others), in order to understand what you meant, and even then it seemed hard to put the information into a larger context. I would advise going over your article and making the language a lot simpler, even explaining the terms in the article rather than just linking every single uncommon term. I applaud you for the information you gathered, it all appears very complex and I am sure it was not easy to get a handle on all of it. I guess the next step is just to make it easier for your readers than it was for you! Gleasoda (talk) 22:54, 8 April 2011 (UTC)

• We have glanced over that wikipedia Manual. Thank you very much for that idea though. I also agree very much that the wording was pretty dense. We have tried for the past few days to make the language less scientific. If there is anything specifically that you think that we have overlooked in terms of simplification, please feel free to let us know. Sean J. Dikdan (talk) 03:50, 29 April 2011 (UTC)

On the first read through, I took away a decent amount of significant information from this article and I found that it was very well organized. There good usage of linking and references – clearly you guys did very thorough research, so kudos to you. For some minor constructive criticism, I think there is an unnecessary overuse of the pronoun “it” in the intro. The intro would read better if in some places you replaced “it” with Cushing reflex or perhaps restructured the sentence to avoid its repetition. In the way of grammatical corrections: “Experiments by Schmidt et al. showed that Cushing reflex directed by autonomic nervous system…” seems incomplete and could be improved by saying “is directed by the autonomic nervous system”. The sentence before seems a little unclear too, so rewording that might help clarify what you mean. While it may be a difficult task to depict the complexity of this reflex and its many levels in a picture, I still think that a few pictures would be helpful if you can find them. As I said, I think one picture wouldn’t do it justice so perhaps searching for multiple small level pictures would be helpful, perhaps one for each stage or one or two to depict the cellular level responses that occur. In the causes section, you stay that the reflex can result from low cerebral perfusion pressure below 15mmHg, but do not include what normal CPP is – I think this would be helpful to gauge how low it really gets. The history and the future research sections certainly put this disease into context and add to its relevance, so nice work on that. The integration of this article into the Wikipedia community can be improved by adding more links under the “see also” section at the bottom, which would also strengthen the relevance your article. Overall, nice job! Danika paulo (talk) 23:56, 8 April 2011 (UTC)

• I did a little bit of rewording in the Intro to make it flow better. Good catch with the grammatical error. That has been fixed. I also changed "et. al." to "and his fellow researchers." to make the sentence read better. Some pictures have been added, and I think they definitely improve the article as a whole. We are in the process of selecting a few more to include. Before editing the article it had a few more "see also' references, but we learned that you are only really supposed to include those links if they don't really appear anywhere significantly in other places of the article. If you have any suggestions along those lines. They would be greatly appreciated. If there are some of your concerns that we didn't address, then please get back us, and THANK YOU for all these great suggestions. Sean J. Dikdan (talk) 21:21, 28 April 2011 (UTC)

Comment Response

Thank you all for your comments. My team and I are currently in the process of compiling all of the various suggestions. Once we do this, we can begin to make some of the various improvements that have been proposed. I have no doubt that through this process, all of your thoughtful commentary will go into making a much stronger article. Thank you again. Sean J. Dikdan (talk) 18:09, 20 April 2011 (UTC)

So after going through the peer review comments, these are the general critiques that I have gotten:

• Expand Introduction
• Add pictures to the article
• Specific sentence structure modifications in:
  • Clinical importance
  • Signs and symptoms
  • Causes

• Add more hyperlinks to article
• Expand on some unexplained abbreviations
• Language in Mechanisms section is too scientific and should be simplified

My team and I will comment on each of the reviews above as I am going through and assessing the article. If anyone feels that I have left out an important general critique, please feel free to message me. Thank you for all your comments Sean J. Dikdan (talk) 06:21, 22 April 2011 (UTC)

We have started responding to peer reviews and re-editing the article. Thank you all again. Sean J. Dikdan (talk) 21:06, 28 April 2011 (UTC)

Merge

Per this page [1] from Uptodate Cushing's reflex and Cushing's triad are the same and thus IMO should be merged. Doc James (talk · contribs · email) 01:10, 26 May 2011 (UTC)

Support the merge. The Triad should be listed as a subsection of this page.--Chimino (talk) 03:53, 4 June 2013 (UTC)

I have completed this merger. LT90001 (talk) 07:25, 27 August 2013 (UTC)

GA Review

This review is transcluded from Talk:Cushing reflex/GA1. The edit link for this section can be used to add comments to the review.

Reviewer: Doc James (talk · contribs · email) 06:27, 18 June 2011 (UTC)

A few comments:

• We need to address the Cushing triad verses Cushing reflex. So refs refer to them interchangeably thus should probably be on the same page.
• As this is a sign / symptom could use an infobox
• Usually we wish articles to be based on review articles per WP:MEDRS but there does not seem to be any
• Needs a section on management ( mannitol, hypertonic saline, head of the bed to 30%, hyperventilations). There is lots of literature on all of these even though much of it is inconclusive.
• Anyway will wait for a reply to these before I comment further.

--Doc James (talk · contribs · email) 06:27, 18 June 2011 (UTC)

Will give the nominator until the 31st of June and then will close if no replies to comments. Doc James (talk · contribs · email) 04:47, 27 June 2011 (UTC)

Respiratory rate confusion

From the definition section: In response to rising intracranial pressure (ICP), respiratory rate increases.[6] The increase in ventilation is exhibited as an increase in rate rather than depth of ventilation, so the Cushing reflex is often associated with slow, irregular breathing.

Respiratory rate is defined as number of breaths taken within a set amount of time, so I'm confused as to what is being stated here. I guess we're talking about an increase in respiratory minute volume? If it's not the depth of ventilation that's increased, maybe shallow instead of slow was meant? Ssscienccce (84.197.178.75) (talk) 14:44, 10 April 2012 (UTC)

If on the other hand we're talking about symptoms during different phases of the Cushing reflex, then this should be made clear, and the phrase "so the Cushing reflex is often associated" should not be used. Ssscienccce (84.197.178.75) (talk) 14:54, 10 April 2012 (UTC)

Mechanism

Under the mechanism section it says: "The pressure in the cerebral spinal fluid eventually rises to the point that it meets and gradually exceeds the mean arterial blood pressure (MABP or MAP). When the ICP exceeds the MABP, arterioles located in the brain's cerebrum become compressed". I find it very hard to believe that the ICP rises to such a degree that it EXCEEDS mean arterial blood pressure. ICP doesn't have to equal or exceed MAP in order to compress arterioles and cause ischaemia. Cerebral Perfusion Pressure(CPP = MAP - ICP) is very tightly regulated and does not have to be 0 or even close to it in order to cause ischaemia. Brain is probably ischaemic at below 70mmHg already, and most certainly at around 50mmHg and below. Next time you're going to make such extreme claims put a citation that can actually be read. — Preceding unsigned comment added by 188.230.240.127 (talk) 14:25, 7 April 2013 (UTC)

Do you know that wikipedia is the encyclopedia that ANYBODY can edit. We do need interested editors so go ahead and fix it yourself: we would be extremely grateful, specially if you brign sources for such a change. If you have any doubts on how to do it simply ask and somebody will give you a hand. Bests.--Garrondo (talk) 15:24, 7 April 2013 (UTC)

Well, this is pretty tough. The literature here isn't large and is very technical, and I don't think an editor who lacks institutional access to medical journals would be able to do much. Looie496 (talk) 15:40, 7 April 2013 (UTC)

Contradiction about tachycardia/bradycardia

The section "Differential diagnosis" has the phrase " Once the initial stage of the Cushing reflex (bradycardia combined with hypertension) was discovered..." whereas the section on "Mechanism" says "Increased heart rate is also known as tachycardia. This combined with hypertension is the first stage of the Cushing reflex..." can anyone who knows for certain what the stages are clarify whether the first stage is tachycardia or bradycardia combined with hypertension? Zchahe7 (talk) 06:44, 7 July 2018 (UTC)