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 Pressure

Read excerpts from these other book chapters related to Pressure:

Copyright Details: In A Page: Pediatric Signs and Symptoms, Copyright © 2008 Williams & Wilkins.

More About Causes of Pressure

• Back to symptom: Pressure: Introduction (review 130 causes)
• Next Book Extract About Pressure: HYPERTENSION (Differential Diagnosis in Primary Care)
• All Book Extracts: All Online Book Extracts for 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

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:

• HYPERTENSION (Differential Diagnosis in Primary Care)
• Blood pressure increase [Hypertension] (Handbook of Signs & Symptoms (Third Edition))
• Blood pressure decrease [Hypotension] (Handbook of Signs & Symptoms (Third Edition))
• Pulse pressure, narrowed (Handbook of Signs & Symptoms (Third Edition))
• Pulse pressure, widened (Handbook of Signs & Symptoms (Third Edition))

Tools & Services:

• Bookmark this page
• Take a survey relating to Pressure
• Symptom Search
• Symptom Checker
• Medical Dictionary
• Give your feedback

Medical Articles:

• Disease & Treatments Search
• Misdiagnosis Center
• Full list of interesting articles

Forums & Message Boards

• Ask or answer a question at the Boards:
• I cannot get a diagnosis. Please help.
• Tell us your medical story.
• Share your misdiagnosis story.
• What is the best treatment for my condition?
• See all the Boards.

Enter your search terms Submit search form
Search The Web Search wrongdiagnosis.com

Common Health Mistakes

Symptom
Checker

Search Specialists by State and City