Raised intracranial pressure

Medicine > Neurosciences

Background knowledge 🧠

Definition

Raised intracranial pressure (ICP) refers to increased pressure within the skull and thus on the brain tissue and cerebrospinal fluid (CSF)
Normal ICP is 7-15 mmHg in adults
ICP over 20 mmHg is typically considered pathological

Epidemiology

Common in traumatic brain injury
Occurs in stroke, hydrocephalus, and brain tumors
Can affect all age groups
Incidence varies with underlying cause

Aetiology and Pathophysiology

Brain tumor
Cerebral edema
Hydrocephalus
Intracranial hemorrhage
Traumatic brain injury
Increased CSF production or decreased absorption

Clinical Features 🌡️

Symptoms

Headache (worse in the morning)
Nausea and vomiting
Blurred vision
Altered mental status
Seizures
Focal neurological deficits

Signs

Papilledema
Cushing’s triad (hypertension, bradycardia, irregular respirations)
Cranial nerve palsies (especially CN VI)
Decreased level of consciousness

Investigations 🧪

Tests

CT scan of the head
MRI of the brain
Lumbar puncture in some cases (if no risk of herniation)
ICP monitoring
Blood tests (e.g., full blood count, electrolytes)
EEG (if seizures suspected)

Management 🥼

Management

Elevate head of bed to 30 degrees
Osmotic agents (e.g., mannitol, hypertonic saline)
Sedation and analgesia
CSF drainage via ventriculostomy
Surgical decompression (e.g., craniectomy)
Treat underlying cause (e.g., antibiotics for infection, surgery for tumor)

Complications

Brain herniation
Permanent neurological deficits
Seizures
Death

Prognosis

Depends on underlying cause and timeliness of treatment
Higher morbidity and mortality if untreated
Early intervention improves outcomes

Key Points

Early recognition and management are crucial
Multidisciplinary approach often required
Regular monitoring of ICP in high-risk patients

No comments yet 😉

Leave a Reply Cancel reply

You must be logged in to post a comment.