Increased Intracranial Pressure

    Increased intracranial pressure (ICP) is a rise in pressure around your brain. It may be caused by an increase in the amount of fluid surrounding your brain.

    For instance, it can be caused by an increased amount of the cerebrospinal fluid that naturally cushions your brain, or by an increase in blood in the brain due to an injury or a ruptured tumor.

    ICP can also mean that your brain tissue itself is swelling, either from injury or from an illness such as meningitis. ICP can be the result of a brain injury; alternately, it can cause a brain injury.

    ICP is a life-threatening condition. A person showing symptoms of ICP must get emergency medical help right away.

    What Are the Symptoms of ICP?

    Signs of ICP include:

    • headache
    • nausea
    • vomiting
    • increased blood pressure
    • decreased mental abilities
    • confusion about time, then location and people as pressure worsens
    • double vision
    • pupils that do not respond to changes in light
    • shallow breathing
    • seizures
    • loss of consciousness
    • coma

    These signs could indicate other serious conditions besides ICP. They are more likely to indicate ICP in a person who has had a stroke, a brain tumor, or a recent head injury.

    Signs of ICP in Infants

    ICP in infants can be the result of child abuse, especially “shaken baby syndrome”—a condition in which a small child has been roughly handled to the point of brain injury. If you have reason to suspect that a child has been abused, you can anonymously call the National Child Abuse Hotline at 1-800-4-A-CHILD (1-800-422-4453).

    Signs of ICP in infants include those for adults and some additional signs unique to babies less than 1 year old. Because the bony plates that form the skull are softer in babies than in older children and adults, they may spread apart in an infant with ICP. This is called separated sutures of the skull. ICP can also cause the fontanelle (the soft spot on the top of a baby’s head) to bulge outward.

    What Are the Causes and Risk Factors for ICP?

    A blow to the head most commonly causes ICP. Other causes include:

    • infections
    • tumors
    • stroke
    • aneurysm
    • epilepsy
    • seizures
    • hydrocephalus (accumulation of spinal fluid in the brain cavities)
    • hypertensive brain injury (when uncontrolled high blood pressure leads to bleeding in the brain)
    • hypoxemia (deficiency of oxygen in the blood)
    • meningitis (inflammation of the protective membranes around the brain and spinal cord)

    How Is ICP Diagnosed?

    Your doctor will need to know some important information about your medical history right away. For example, whether you have recently suffered a blow to the head, or if you know you have a brain tumor. The doctor will then begin a physical exam. He or she will check your blood pressure and check to see if your pupils are dilating properly.

    He or she may also measure the pressure of your cerebrospinal fluid using a lumbar puncture (spinal tap). Images of the brain from a computed tomography (CT) scan or magnetic resonance imaging (MRI) scan may be necessary to confirm the diagnosis.

    What Are the Treatments for ICP?

    The most urgent goal of treatment is to reduce the pressure inside your skull. Then, any underlying conditions can be addressed.

    Effective treatments to reduce pressure include draining the fluid through a shunt (small hole) in the skull or via the spinal cord. The medications mannitol and hypertonic saline can also be used to lower pressure. They work by removing fluids from your body. Because anxiety can make ICP worse by raising your blood pressure, you may be given a sedative as well.

    Less common treatments for ICP include:

    • removing part of the skull
    • medicines to induce coma
    • deliberately chilling the body (induced hypothermia)

    What Is the Outlook for Someone with ICP?

    The sooner the pressure on your brain is reduced, the better the outcome. Delayed treatment or failure to reduce intracranial pressure can cause temporary brain damage, permanent brain damage, long-term coma, or even death.

    Can ICP Be Prevented?

    ICP can’t be prevented, but head injury—its leading cause—often can. Always wear a helmet when you bike or play contact sports. Wear your seatbelt when driving and keep your seat back as far as possible from the dashboard or the seat in front of you. Always buckle children into a child safety seat.

    Falling at home is a common cause of head injury, especially in the elderly. Avoid falls at home by keeping floors dry and uncluttered. If necessary, install handrails.