In the context of Cushing reflex in TBI, which statement is accurate?

• A. Signals increased intracranial pressure and potential brain herniation.
• B. Indicates low intracranial pressure.
• C. Always accompanies fever.
• D. Represents a normal autonomic response.

Answer: (A)

The main idea here is that the Cushing reflex is a late, dangerous sign of rising intracranial pressure. As ICP increases, cerebral perfusion pressure drops, and the body tries to compensate by boosting systemic blood pressure to keep blood flow to the brain. This sympathetic surge leads to hypertension, while the baroreceptor response causes reflex bradycardia. Brainstem involvement can produce irregular respirations. Taken together, these signs point to increased ICP with a risk of brain herniation, which is why the statement that it signals increased intracranial pressure and potential brain herniation is the most accurate. It is not about low ICP, it isn’t inherently fever-related, and it’s not a normal autonomic response—it's a critical warning sign requiring urgent management.