Cushing described peptic ulceration occurring in patients undergoing neurosurgery. The frequency of Cushing ulcers has decline with stress ulcer prophylaxis.
Cushing ulcers can occur with an increase in intracranial pressure including:
(1) neurosurgery
(2) head trauma
(3) stroke
The patient develops a peptic ulcer, usually in the duodenum.
A patient with elevated serum gastrin levels may be at increased risk for peptic ulceration.
The presence of concurrent gastritis may increase the risk.
The use of corticosteroids (dexamethasone to reduce the intracranial pressure, etc) may increase the risk for peptic ulceration and may obscure early symptoms. Corticosteroids increase the risk of ulcer by reducing mucosal protection (through reduction in gastric mucus production and gastric fluid bicarbonate).
Complications:
(1) gastrointestinal bleeding
(2) perforation
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