Bradycardia without hypertension and bradypnea in acute traumatic subdural hematoma is a sensitive predictor of the Cushing triad: 3 case reports

Abstract

Acute traumatic subdural hematomas (SDHs) are very common. These hematomas are usually neurosurgical emergencies, although conservative therapy is indicated in certain cases. SDH can increase intracranial pressure (ICP) and compress or stretch the brainstem. Lately, it has been recognized that increased ICP can lead to hemodynamic instability and bradycardia. Bradycardia can be an early warning sign in many neurosurgical conditions. We observed bradycardia in serial cases of the patient without hypertension and bradypnea, classically known as Cushing's triad, in an acute traumatic SDH patients who were receiving conservative treatment and the bradycardia were proved as an early sign of an increasing ICP. The onset of bradycardia can indicate the need for further evaluation from a conservative management strategy to perform definitive surgery treatment.