Cushing's reflex in a rare case of adult medulloblastoma.

BACKGROUND: Medulloblastoma is a primitive neuro-ectodermal tumor. It is common in childhood, but rarely seen at adult age, comprising only 1% of primary brain tumors.

METHODS: We treated a 31-year-old man presented to the emergency department (ED) with a chief complaint of nausea and vomiting for one week duration. Immediate frozen section revealed a grade IV medulloblastoma. During the hospital course, the patient was given craniospinal irradiation with chemotherapy.

RESULTS: The patient was eventually discharged from the hospital to an assisted living facility after an uneventful 15-day course with the aid of social work.

CONCLUSIONS: Despite intracranial tumors generally being slow growing masses, this patient demonstrates how quickly one can decompensate, and how important it is to recognize these clinical signs and symptoms of an intracranial lesion. Although these symptoms (i.e. Cushing response) are extremely rare, the ED physician should be aware and appreciate their clinical significance.