Occult duodenal perforation complicating cerebral infarction: New problems in diagnosis of Cushing's ulcer

T. J. Walsh, R. Raine, W. H. Chamberlin, C. L. Rice

Research output: Contribution to journalArticle

Abstract

Cushing's ulcers of the duodenum are well known complications of neurosurgery, head trauma, and other causes of increased intracranial pressure. Perforation of Cushing's ulcer of the duodenum is infrequently described. That the use of high-dose corticosteroids for cerebrovascular infarct in an aphasic patient may obscure the symptomatology and physical findings of a perforated Cushing's ulcer has not been described to our knowledge. We report a patient with a large left hemispherical infarct and resultant aphasia who developed a perforated duodenal ulcer and extensive chemical peritonitis while receiving high dose corticosteroids for increased intracranial pressure. She was unable to register any complaints and the typical physical findings of perforated duodenal ulcer with chemical peritonitis were virtually absent. A high index of suspicion must be maintained for perforated Cushing's duodenal ulcer in the patient receiving high dose dexamethasone despite the presence of nonspecific symptomatology and abdominal findings. Elevated serum gastrin levels, as in this patient, may also indicate the patients with increased intracranial pressure who are at greater risk for developing Cushing's ulcer.

Original languageEnglish (US)
Pages (from-to)608-610
Number of pages3
JournalAmerican Journal of Gastroenterology
Volume77
Issue number9
StatePublished - 1982
Externally publishedYes

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Cerebral Infarction
Ulcer
Intracranial Pressure
Duodenal Ulcer
Peritonitis
Duodenum
Adrenal Cortex Hormones
Aphasia
Gastrins
Neurosurgery
Craniocerebral Trauma
Dexamethasone
Serum

ASJC Scopus subject areas

  • Gastroenterology

Cite this

Occult duodenal perforation complicating cerebral infarction : New problems in diagnosis of Cushing's ulcer. / Walsh, T. J.; Raine, R.; Chamberlin, W. H.; Rice, C. L.

In: American Journal of Gastroenterology, Vol. 77, No. 9, 1982, p. 608-610.

Research output: Contribution to journalArticle

Walsh, T. J. ; Raine, R. ; Chamberlin, W. H. ; Rice, C. L. / Occult duodenal perforation complicating cerebral infarction : New problems in diagnosis of Cushing's ulcer. In: American Journal of Gastroenterology. 1982 ; Vol. 77, No. 9. pp. 608-610.
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