Increased Intracranial Pressure
Normal intracranial pressure (ICP) is 5–20 cm H2O. Any addition of volume to the contents of the cranium can potentially elevate the ICP. Elevated ICP can lead to brain damage by either mechanical compression/herniation of the brain or by decreasing cerebral perfusion pressure (CPP) and cerebral blood flow.
Differential Diagnosis
-
Hydrocephalus
–Due to either increased production or decreased absorption (more likely) of CSF
-
Communicating hydrocephalus
–Post-hemorrhage
–Postinfectious
–Choroid plexus papilloma
–Vein of Galen aneurysm
-
Noncommunicating hydrocephalus
–Arnold-Chiari malformation
–Aqueductal stenosis
–Mass lesion
–Ependymoma, astrocytomas
–Abscess
–Intraventricular hemorrhage, subarachnoid hemorrhage
-
Hypoxic ischemic encephalopathy
-
Head trauma
-
Pseudotumor cerebri (benign intracranial hypertension) due to hypervitaminosis A; steroid withdrawal or administration; tetracycline; oral contraceptive pills; or idiopathic
-
Systemic infections
–Roseola
–Shigella
–Otitis media
-
Meningitis/encephalitis
-
Neoplasm
-
Intracranial hemorrhage: Subdural hematoma, epidural hematoma, intraventricular hemorrhage
-
Metabolic causes: DKA, hepatic encephalopathy, uremia, MSUD, urea cycle defects
-
Endocrine
–Addison disease, hypoparathyroidism, hypothyroidism
-
Abscess
-
Venous sinus thrombosis
-
Congestive heart failure
-
Obstructed venous return
-
Lead encephalopathy
-
Status epilepticus
-
Stroke
-
Acute hyponatremia
-
Reye syndrome
Workup and Diagnosis
- History
–History of trauma, seizures, vomiting
–Double or blurry vision
–Diabetes; cardiac, liver, or renal disease
–Birth history
–Fever, neck stiffness, headache
–Recent use of aspirin, antibiotics, steroids, vitamin A
- Physical exam
–Vital signs, temperature, ABCs
–Breathing pattern (Cheyne-Stokes, apneustic, ataxic)
–Retinal hemorrhages, otorrhea, spinal fluid rhinorrhea
–Cardiac exam, hepatosplenomegaly, meningismus
–Neuro exam: Response to voice and noxious stimulation, papilledema, pupillary size and light reflex, eye movements (spontaneous, doll's, caloric), corneal and gag reflexes, motor response to pain, decerebrate or decorticate posturing, muscle tone, DTRs, Babinski sign
–Signs of herniation: Change in respiratory pattern, unilateral dilatation of pupil, ptosis, decreased heart rate, increased blood pressure
-
Labs
–Glucose, electrolytes, ABG, LFT, ammonia, BUN, creatinine, type and cross
-
CT without contrast should be performed immediately
-
LP for meningitis or subarachnoid hemorrhage
–Contraindicated if signs of herniation or mass lesion
-
C-spine X-rays if there is history of trauma
Treatment
-
Highly elevated ICP can be rapidly fatal
–First ABCs, look for signs of herniation
–Obtain intravenous access
-
Keep head of the bed elevated at 15–30°
–Intubate and hyperventilate
–IV mannitol with or without furosemide
-
If comatose, ICP monitoring is indicated
–CPP is defined as mean arterial pressure minus ICP
–CPP should be kept above 70 mmHg
-
Vasogenic edema (e.g., neoplasm or abscess)
–Use dexamethasone
-
IV fluids
–Use isotonic fluids (normal saline)
-
Treat fever aggressively
–Temperature elevations can increase ICP further
-
Seizure prophylaxis should be considered
–High-dose pentobarbital lowers refractory ICP
-
Pseudotumor
–Treat with serial LP, diuretics, or surgery
Book Source Details
- Book Title: In A Page: Pediatric Signs and Symptoms
- Author(s): Jonathan E. Teitelbaum, Kathleen O. Deantonis, Scott Kahan
- Year of Publication: 2007
- Copyright Details: In A Page: Pediatric Signs and Symptoms, Copyright © 2007 Lippincott Williams & Wilkins.
Other Book Chapters Related to Increased intracranial pressure
Read excerpts from these other book chapters related to Increased intracranial pressure:
Copyright Details: In A Page: Pediatric Signs and Symptoms, Copyright © 2008 Williams & Wilkins.
More About Causes of Increased intracranial pressure
|
|
More About This Book:
Title: In A Page: Pediatric Signs and Symptoms
Authors: Jonathan E. Teitelbaum, Kathleen O. Deantonis, Scott Kahan
Publisher: Lippincott Williams & Wilkins
Copyright: 2007
ISBN: 1-4051-0427-9
|
|
» Next page:
ASPARTATE AMINOTRANSFERASE, ALANINE AMINOTRANSFERASE, AND LACTIC DEHYDROGENASE ELEVATION (Differential Diagnosis in Primary Care)
Rate This Website
What do you think about the features of this website?
Take our user survey and have your say:
Website User Survey
Medical Tools & Articles:
Next articles:
Tools & Services:
Medical Articles:
Forums & Message Boards
- Ask or answer a question at the Boards:
