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  • Toward the Explaining of a Pathophysiological Mechanism of Cushing Ulcers During Subarachnoid Hemorrhage: Experimental Study

    Final Number:

    Mehmet Resid Onen MD; Ulas Cikla MD; Ilhan Yilmaz MD; Mehmet Dumlu Aydin

    Study Design:
    Laboratory Investigation

    Subject Category:

    Meeting: Congress of Neurological Surgeons 2015 Annual Meeting

    Introduction: In patients with subarachnoid hemorrhage (SAH) acute gastrointestinal bleeding is a serious complication. In SAH’s early period, gastrointestinal bleeding and mucosal ulcerations occur with increased acid secretion linked to ischemia of the vagal nerve. In the later period, it might result from mucosal degeneration. However, these pathways have not been studied in detail. This study researches the role of vasogastrik reflex on the development of cushing’s ulcers in the subarachnoid hemorrhage.

    Methods: This study was used on 30 rabbits, with 5 rabbits in the control group (group I), 5 rabbits in the sham group (group II), and 20 rabbits in the SAH group. In the SAH group, ten of the animals were decapitated seven days after having been given cisternal blood injections (early group III), and the other ten animals were decapitated 21 days after the injections (late group IV). Gastric ulcers were induced in rabbits by administrating blood to the cisterna magna. The ulceration area was measured based on the product of length and width of the ulcers present in the glandular portion of the stomach (/mm2) and number of gastric follicles were counted

    Results: All data are shown in the Table 1. Group III and group IV were compared with the SHAM group and the areas of ulceration in these two groups were found to be significantly more than was found in the SHAM group (p<0.05).

    Conclusions: In SAH with aneurysm rupture, increased HCI secretion seems to be triggered by hemorrhage in the early phase which is not possible in the late phase because of vagal nerve degeneration. This is the first study to show the vagal network ischemia and gastric ulcerations as a causative factor in the development of acute gastric bleeding after SAH. And vagal network insult could be a result of decreased HCL secretion in the late phase of SAH.

    Patient Care: In the treatment of SAH complications

    Learning Objectives: . This study researches the role of vasogastrik reflex on the development of cushing’s ulcers in the subarachnoid hemorrhage.


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