Cushing’s Triad

What Is It, Causes, Assessment Findings, Treatment, and More

Author: Ashley Mauldin, MSN, APRN, FNP-BC

Editors: Ahaana Singh, Ian Mannarino, MD, MBA

Illustrator: Aileen Lin

What is Cushing’s triad?

Cushing’s triad refers to a set of signs that are indicative of increased intracranial pressure (ICP), or increased pressure in the brain. Cushing’s triad consists of bradycardia (also known as a low heart rate), irregular respirations, and a widened pulse pressure. A widened pulse pressure occurs when there is a large difference between the systolic blood pressure (the blood pressure when the heart is contracting) and the diastolic blood pressure (the blood pressure when the heart is relaxing). Cushing’s triad is indicative of a medical emergency and medical attention is required. 

What causes Cushing’s triad?

  • Increased ICP results in a lack of oxygen in brain tissue and a restriction of cerebral blood flow in the brain. 

    • This is most commonly caused by a head injury, bleeding in the brain (i.e. hematoma or hemorrhage), tumor, infection, stroke, excess cerebrospinal fluid, or swelling of the brain. 

  • Increased ICP activates the Cushing reflex, a nervous system response resulting in Cushing’s triad. 

    • As the ICP begins to increase, it eventually becomes greater than the mean arterial pressure, which typically must be greater than the ICP in order for the brain tissue to be adequately oxygenated

    • As the pressure in the brain continues to rise, the brain stem may start to dysfunction, resulting in irregular respirations followed by periods where breathing ceases completely. This progression is indicative of a worsening prognosis. 

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What are the signs and symptoms of Cushing's triad?

  • Widened pulse pressure

  • Bradycardia 

  • Irregular respirations (also known as Cheyne–Stokes respirations

    • Cheyne-Stokes respirations consist of periods of slow, deep breaths followed by periods of apnea, when breathing comes to a complete stop. 

  • Hypertension, or increased blood pressure 

  • Additional symptoms 

    • Headaches

    • Vomiting

    • Blurred vision

    • Weakness

    • Changes in behavior or level of consciousness

What are the assessment findings of Cushing’s triad?

  • Procedural diagnosis is necessary to definitively diagnose Cushing’s triad by measuring ICP.

  • Clinical evaluation can be performed to help determine the underlying cause.

    • Medical history review

    • Physical examination 

  • Imaging may be required to determine the underlying cause.

    • CT scans 

    • MRI

How do you treat Cushing’s triad?

Treatment is aimed at decreasing the ICP, as well as reversing the cause of the increased intracranial pressure. Prescribed treatment is often individualized and will depend on the severity of the symptoms. 

If Cushing's triad is left untreated for too long, 

  • Herniation can occur, causing the brain tissue to shift to the opposite side of the brain or down towards the brainstem (uncal herniation). 

  • Infarction, or death of the brain tissue, can occur. 

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Related links

Brain Herniation
Intracranial hypertension
Osmotic Diuretics
Traumatic Brain Injury

Resources for research and reference

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Del Maestro R. (2007). Harvey Cushing: A Life in Surgery. Canadian Journal of Surgery, 50(1): 70–71. Retrieved October 21, 2020 from

Dinallo, S. & Waseem, M. (2020). Cushing Reflex. In StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing. Retrieved October 21, 2020, from

Increased ICP – Treatment. (2020). In OpenAnesthesia. Retrieved September 28, 2020, from

Increased Intracranial Pressure (ICP) Headache. (n.d.).  In Johns Hopkins Medicine. Retrieved September 28, 2020, from

Liferidge, A. (2020). UMEM Educational Pearls. In University of Maryland School of Medicine. Retrieved September 28, 2020, from