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Increased intracranial pressure

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

Alternative Names

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

Causes

Increased intracranial pressure can be due to a rise in pressure of the cerebrospinal fluid. This is the fluid that surrounds the brain and spinal cord. Increase in intracranial pressure can also be due to a rise in pressure within the brain itself. This can be caused by a mass (such as a tumor), bleeding into the brain or fluid around the brain, or swelling within the brain itself.

An increase in intracranial pressure is a serious medical problem. The pressure 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:

Symptoms

Infants:

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

Older children and adults:

Exams 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 other nervous system problems.

An MRI or CT scan of the head can usually determine the cause of increased intracranial pressure 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 into a hollow area in the brain called the ventricle.

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
  • Medicines to decrease swelling
  • Removal of part of the skull, especially in the first 2 days of a stroke that involves brain swelling

If a tumor, hemorrhage, or other problem has caused the increase in intracranial pressure, these problems will be treated.

Outlook (Prognosis)

Sudden increased intracranial pressure is a serious and often life-threatening condition. Prompt treatment results in better outlook.

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

Possible Complications

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

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 help as soon as possible.

References

DeAngelis LM. Tumors of the central nervous system and intracranial hypertension and hypotension. In: Goldman L, Schafer AI, eds. Goldman's Cecil Medicine. 24th ed. Philadelphia, Pa: Elsevier Saunders; 2011:chap 195.

Rosenberg GA. Brain edema and disorders of cerebrospinal fluid circulation. In: Daroff RB, Fenichel GM, Jankovic J, Mazziotta JC, eds. Bradley’s Neurology in Clinical Practice. 6th ed. Philadelphia, Pa: Elsevier Saunders; 2012:chap 59.

Cruz-Flores S, Berge E, Whittle, R. Surgical decompression for cerebral oedema in acute ischaemic stroke. Cochrane Database of Syst Rev. 2012:Jan 18; 1:CD003435.

Updated: 5/28/2013

Luc Jasmin, MD, PhD, FRCS (C), FACS, Department of Neurosurgery at Cedars-Sinai Medical Center, Los Angeles CA; Department of Surgery at Los Robles Hospital, Thousand Oaks CA; Department of Surgery at Ashland Community Hospital, Ashland OR; Department of Surgery at Cheyenne Regional Medical Center, Cheyenne WY; Department of Anatomy at UCSF, San Francisco CA. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Bethanne Black, and the A.D.A.M. Editorial team.


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