Increased intracranial pressure

Definition

An increase in normal brain pressure can be due to an increase 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.

Causes, incidence, and risk factors

An increase in your intracranial pressure is a severe medical problem. The pressure itself can be responsible for further damage to the central nervous system by causing compression of important brain structures and by restricting blood flow through blood vessels that supply the brain.

Many conditions can increase intracranial pressure. Common causes include:

• severe head injury
• subdural hematoma
• hydrocephalus
• brain tumor
• hypertensive brain hemorrhage
• intraventricular hemorrhage
• meningitis
• encephalitis
• aneurysm rupture and subarachnoid hemorrhage
• status epilepticus
• stroke

Symptoms

Infants:

• bulging fontanelle
• separated sutures
• lethargy
• vomiting

• vomiting
• headache
• changes in behavior
• progressive decreased consciousness, lethargy
• neurologic deficits
• seizures

Signs and tests

A diagnosis of raised intracranial pressure is made at the patient's bedside. An MRI or CT scan is often used to determine the cause and confirm the diagnosis.

Intracranial pressure is measured in millimeters of mercury (mm Hg). Intracranial pressure may be measured during a spinal tap (lumbar puncture). It may also be measured directly by a calibrated device. This device is drilled through the skull to measure the pressure on the surface of the brain, or a catheter is inserted to allow it to measure the pressure inside the brain.

Treatment

This condition is critical. The person will be in intensive care and have neurologic and vital signs measured frequently. Treatment may include altering breathing rate, medications to decrease swelling, or drainage of cerebrospinal fluid to lower pressure in the brain. If the raised intracranial pressure is cause by a mass lesion, like a tumor or hemorrhage, then the cause of the raised pressure should be treated.

Expectations (prognosis)

Raised intracranial pressure is a serious and often fatal condition. If the underlying cause of the raised intracranial pressure is treatable, then the outlook is generally better. Compression of vital brain structures and blood vessels can lead to serious, permanent neurologic deficits or even death.

Complications

• Reversible neurologic problems
• Permanent neurologic problems
• Seizures
• Death

Calling your health care provider

This diagnosis is usually made in an emergency room or hospital setting. Primary care physicians are sometimes able to identify early signs of raised intracranial pressure when symptoms like headache, seizures, or neurologic problems arise.

Prevention

Raised intracranial pressure is often not preventable. Patients with persistent headache, blurred vision, altered level of conciousness, neurologic deficits, and seizures should seek medical attention as soon as possible.

Illustrations

Subdural hematoma

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