Increased intracranial pressure (ICP) is an increase in pressure around the brain, likely due to an excess of fluid. It’s life threatening and requires immediate medical attention.
For example, there may be an increased amount of cerebrospinal fluid that naturally cushions your brain or an increase in blood in the brain due to an injury or a ruptured tumor.
Increased ICP can also mean that your brain tissue itself is swelling, either from injury or from an illness like tumors, infection (like meningitis or encephalitis), or idiopathic intracranial hypertension. Increased ICP can be the result of a brain injury, and it can also cause a brain injury.
The signs and symptoms of increased ICP include:
- increased blood pressure
- decreased mental abilities
- double vision
- pupils that don’t respond to changes in light
- shallow breathing
- loss of consciousness
Many of these symptoms can appear with other conditions, but things like confusion and behavior changes are common early signs of increasing intracranial pressure. Your doctor will usually use other symptoms or knowledge of your personal and family medical history to determine the cause of your symptoms.
A red flag for increased intracranial pressure as a cause — and a sign of the need for emergency care — is the development of several of these symptoms at once.
Cushing’s Triad is a term used to describe three symptoms that happen together and usually signal increased intracranial pressure that requires immediate care. These symptoms include:
- irregular breathing patterns
- an increasing gap between your systolic and diastolic blood pressures (widened pulse pressure)
- a drop in your heart rate
Increased intracranial pressure can also be a sign of other serious and even fatal problems like stroke, a brain tumor, or a recent head injury.
What does increased intracranial pressure feel like?
Some people are born with conditions that lead to increased intracranial pressure, and others can develop this condition after neurologic diseases or injury.
While increased ICP is always a medical emergency, some people reach tolerable levels, often aided by things like devices to drain extra cerebrospinal fluid.
There are lots of symptoms that can develop with increased ICP, but people who experience this commonly report things like:
- balance problems
- intense headaches
- nausea or vomiting
- coordination problems
- vision changes
Signs of increased ICP in infants
Symptoms of increased ICP in infants include those for adults, but there are some additional signs unique to babies under 12 months 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 increased ICP. This is called separated sutures of the skull.
Increased ICP can also cause the fontanel, the soft spot on the top of a baby’s head, to bulge outward.
Increased ICP in infants can be the result of injury, like falling off a bed, or it can be a sign of child abuse known as 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 is the victim of abuse, you can anonymously call the National Child Abuse Hotline at 800-4-A-CHILD (800-422-4453).
Head trauma is a major cause of increased intracranial pressure, but there are other things that can lead to this problem, too. Other possible causes of increased ICP include:
- hydrocephalus, which is an accumulation of spinal fluid in the brain cavities
- hypertensive brain injury, which is when uncontrolled high blood pressure leads to bleeding in the brain
- hypoxemia, which is a deficiency of oxygen in the blood
- meningitis, which is inflammation of the protective membranes around the brain and spinal cord
- idiopathic intracranial hypertension
Overall, your intracranial pressure usually increases as a direct result of too much fluid inside your skull or some type of inflammation or swelling in your brain.
Can medications cause increased intracranial pressure?
In addition to the injuries and conditions discussed above, there are several medications that
- withdrawal from systemic corticosteroids
- recombinant growth hormones
- lithium carbonate
- nalidixic acid
- sulfonamide antibiotics
- tetracycline antibiotics like doxycycline and minocycline
- vitamin A supplements and retinoic acids
- some oral contraceptives
Your doctor will need to know some important information about your family and personal medical history right away if increased ICP is suspected as the cause of your symptoms.
They’ll ask if you recently suffered a blow to the head or if you’ve been diagnosed with a brain tumor. You should also provide your doctor with a list of any medications or supplements you may be taking.
The doctor will then begin a physical exam. This will include a review of your vital signs and a detailed neurological exam investigating things like your:
- pupil reactions
- visual acuity
- movement and coordination
Once a brain scan, such as a CT of the head or MRI of the brain, has ruled out a mass or tumor, the doctor may also measure the pressure of your cerebrospinal fluid using a lumbar puncture, or spinal tap. This way they can measure intracranial pressure for conditions such as idiopathic intracranial hypertension
In cases of severe increases in intracranial pressure that usually lead to critical illness, your doctor may need to place an invasive intracranial monitoring tool that will provide a direct reading using a thin tube (catheter), bolt, or sensor placed inside your skull.
This type of monitoring is considered effective for measuring ICP but can also lead to a number of complications like additional injury or infection.
The most urgent goal of treatment is to reduce the pressure inside your skull. This can be done in a number of ways, including:
- placing a shunt through a small hole in the skull or in the spinal cord to drain excess cerebrospinal fluid
- using medications like mannitol and hypertonic saline to lower pressure
- sedation to reduce anxiety and neurological responses
- removing part of the skull to allow your brain space to expand without damage (craniotomy)
- slowing neurological function to reduce damage
- inducing hypothermia to bring down your overall body temperature and slow metabolism
The next step in treating increased ICP is to figure out what caused the problem in the first place. If your increased intracranial pressure was caused by things like an infection or stroke, those underlying problems will need to be treated alongside your increased ICP.
Resolving whatever caused the problem will help reduce pressure from continuing to increase.
You can’t prevent increased ICP, but you can prevent head injury.
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 older adults. Avoid falls at home by keeping floors dry and uncluttered. If necessary, install handrails.
Delayed treatment or failure to reduce intracranial pressure can cause temporary brain damage, permanent brain damage, long-term coma, or even death.
The sooner you seek treatment to reduce pressure on your brain, the better the outcome. The use of invasive intracranial monitoring devices is associated with a better prognosis, especially when your increased ICP was caused by a traumatic brain injury.
Overall, your prognosis will depend somewhat on what caused your elevated ICP. If your ICP increase is caused by a congenital issue, your cerebrospinal fluid levels can be managed effectively in many cases to avoid fatal complications.
However, in cases of traumatic brain injury and other conditions that can drive your ICP to severely high levels, the outcome can be fatal.
Signs of severe problems from increased ICP and a poor prognosis include things like:
- a physical shift of your brain on imaging scans
- abnormal positioning (posturing) of your limbs or body
- development of other neurologic complications like diabetes insipidus or poor temperature control
- poor pupil responses
- a lack of basic neurological responses
Elevated intracranial pressure is a medical emergency in nearly every case. No matter what the cause of the pressure increase, it can lead to brain damage and other fatal complications if pressure increases become too high.
There are times when this problem can develop as part of a chronic or congenital condition, but when it happens suddenly, quick medical care is needed to avoid a fatal outcome.
If you experience a sudden intense headache, lose consciousness, or have other unexplained neurological conditions, seeking immediate medical care is the best way to avoid fatal complications.