Increased intracranial pressure

Definition

Increased intracranial pressure is a rise in normal brain pressure.

Alternative Names

ICP; Intracranial pressure - increased

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 lesions (such as a tumor) or swelling within the brain matter itself.

An increase in intracranial pressure is a serious medical problem. The pressure itself can damage the central nervous system by pressing on important brain structures and by restricting blood flow through blood vessels that supply the brain.

Many conditions can increase intracranial pressure. Common causes include:

• Aneurysm rupture and subarachnoid hemorrhage
• Brain tumor
• Encephalitis
• Hydrocephalus
• Hypertensive brain hemorrhage
• Intraventricular hemorrhage
• Meningitis
• Severe head injury
• Subdural hematoma
• Status epilepticus
• Stroke

Symptoms

Infants:

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

• Behavior changes
• Headache
• Progressive decreased consciousness, lethargy
• Neurologic 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 raised intracranial pressure, such as headache, seizures, or neurologic problems.

An MRI or CT scan 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

Increased intracranial pressure is an emergency. The person will be 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

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

Expectations (prognosis)

Raised 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 neurologic problems
• Reversible neurologic problems
• Seizures

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 alert level, neurological problems, or seizures, seek medical attention as soon as possible.