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Increased intracranial pressure

Definition

Increased intracranial pressure is a rise in the pressure inside the skull that can result from or cause brain injury.

Alternative Names

ICP; Intracranial pressure - increased; Intracranial hypertension; Acute increased intracranial pressure; Sudden increased intracranial pressure

Causes, incidence, and risk factors

Increased intracranial pressure can be due to a rise in cerebrospinal fluid pressure. It can also be due to increased pressure within the brain matter caused by a mass (such as a tumor), bleeding into the brain or fluid around the brain, or swelling within the brain matter itself.

An increase in intracranial pressure is a serious medical problem. The pressure itself can damage the brain or spinal cord by pressing on important brain structures and by restricting blood flow into the brain.

Many conditions can increase intracranial pressure. Common causes include:

• Aneurysm rupture and subarachnoid hemorrhage
• Brain tumor
• Encephalitis
• Hydrocephalus (increased fluid around the brain)
• Hypertensive brain hemorrhage
• Intraventricular hemorrhage
• Meningitis
• Severe head injury
• Subdural hematoma
• Status epilepticus
• Stroke

Symptoms

Infants:

• Drowsiness
• Separated sutures
• Bulging of the soft spot on top of the head (bulging fontanelle)
• Vomiting

Older children and adults:

• Behavior changes
• Decreased consciousness
• Headache
• Lethargy
• Neurological problems
• Seizures
• Vomiting

Signs and tests

A health care provider will usually make this diagnosis at the patient's bedside in an emergency room or hospital. Primary care doctors may sometimes spot early symptoms of increased intracranial pressure such as headache, seizures, or neurological problems.

An MRI or CT scan of the head can often determine the cause and confirm the diagnosis.

Intracranial pressure may be measured during a spinal tap (lumbar puncture). It can also be measured directly by using a device that is drilled through the skull or a tube (catheter) that is inserted inside the brain.

Treatment

Sudden increased intracranial pressure is an emergency. The person will be treated in the intensive care unit of the hospital. The health care team will measure and monitor the patient's neurological and vital signs, including temperature, pulse, breathing rate, and blood pressure.

Treatment may include:

• Breathing support
• Draining of cerebrospinal fluid to lower pressure in the brain
• Medications to decrease swelling
• Rarely, removal of part of the skull

If a tumor, hemorrhage, or other underlying problem has caused the increase in intracranial pressure, the cause should be treated as appropriate.

For information regarding treatment for certain causes of increased intracranial pressure, see:

• Hydrocephalus
• Normal pressure hydrocephalus

Support Groups

Expectations (prognosis)

Sudden increased intracranial pressure is a serious and often deadly condition. If the underlying cause of the raised intracranial pressure can be treated, then the outlook is generally better.

If the increased pressure pushes on important brain structures and blood vessels, it can lead to serious, permanent problems or even death.

Complications

• Death
• Permanent neurological problems
• Reversible neurological problems
• Seizures
• Stroke

Calling your health care provider

A health care provider will usually make this diagnosis in an emergency room or hospital.

Prevention

This condition usually cannot be prevented. If you have a persistent headache, blurred vision, changes in your level of alertness, neurological problems, or seizures, seek medical attention as soon as possible.

References

Ling GSF. Traumatic brain injury and spinal cord injury. In: Goldman L, Ausiello D, eds. Cecil Medicine. 23rd ed. Philadelphia, Pa: Saunders Elsevier; 2007: chap 422.