Alternate Names: ICP; Intracranial pressure - increased

Causes and Risks: Increased intracranial pressure is almost always indicative of severe medical problems. The pressure itself can be responsible for further damage to the central nervous system by decreasing blood flow to the brain or by causing the brain to herniate (push through) the opening in the back of the skull where the spinal cord is attached. Sudden herniation through the foramen magnum (back of the skull) is fatal.

Many conditions can cause increases in the intracranial pressure including metabolic, toxic, traumatic, infectious, neoplastic and idiopathic. Common causes include:

• severe head injury
• battered child syndrome
• subdural hematoma
• intraventricular hemorrhage
• meningitis
• meningoencephalitis
• lead poisoning
• Reye’s syndrome
• hypervitaminosis A
• diabetic ketoacidosis (during treatment)
• water intoxication (psychogenic polydipsia)
• decerebrate posture
• decorticate posture
• fontanelles - bulging

Prevention: Use proper precautions to avoid head injury. See the individual causes above for other preventive measures.

Symptoms: Infants:

• bulging fontanelle
• separated sutures

• vomiting
• headache
• changes in behavior
• progressive decreased consciousness, may become coma
• seizures

Signs and Tests: Intracranial pressure is measured in millimeters of mercury (mm Hg) and the upper limits of normal are around 180 to 200 mm Hg. Intracranial pressure may be measured during a spinal tap (lumbar puncture) or may be measured directly by attaching a device referred to as a bolt to a small hole in the skull.

Treatment: This condition is critical. The affected person will be in the hospital, possibly in an intensive care unit. They will be monitored and treated aggressively with a breathing tube (intubation), medication, and close monitoring.

Home care instructions will be sent home after the condition that caused the increased pressure has been resolved.

Prognosis: Herniation of the brainstem can be fatal. Slow increases may be tolerated fairly well if the condition causing the increase can be controlled.

Complications:

• brainstem herniation

Children and adults with increased intracranial pressure are, by the time the diagnosis is made, in the hospital.