Causes and risk factors
Several conditions can raise the ICP such as tumors of the brain, infarctions, intracranial hemorrhages, brain abscesses, Foster-Kennedy syndrome, and Guillain-Barre syndrome. Other causes include pseudotumor cerebri, malignant hypertension, heart failure, liver failure, respiratory failure, meningitis, and hypertensive encephalopathy. Raised ICP can even be idiopathic.
Clinical presentation
Raised ICP produces papilledema, i.e., swelling of the optic disc. Commonly occurring symptoms of ICP include headache and sudden vomiting. The headache is worse on coughing. Later, symptoms include blurring of vision and development of a blind spot eventually leading to a total loss of vision. The consciousness becomes altered giving rise to changes in the personality and behavior. Infants may present with bulging fontanels. Other symptoms will be present depending upon the cause of raised intracranial pressure.
Investigations
An eye exam via ophthalmoscopy and slit lamp examination detects papilledema. Laboratory tests are performed to check the levels of glucose, electrolytes, liver function enzymes, and renal function enzymes in the blood.
Imaging scans such as CT or MRI of the brain may be done. Lumbar puncture with cerebrospinal fluid examination serves as a diagnostic as well as therapeutic tool.
In severe cases, the ICP is monitored continuously.
Treatment
The treatment will be decided on the basis of the underlying cause of raised ICP. The possible treatment options include:
- Stabilization of the airways, breathing, blood pressure, and blood sugar levels.
- Use of medications such as diuretics, anti-inflammatory drugs, anti-seizure medications, analgesics, and antipyretic drugs.
- Carrying out a procedure known as ‘lumbar puncture’ to drain the cerebrospinal fluid.
- Surgical procedures in the form of insertion of intracranial transducers, catheters, and craniotomy (drilling holes in the skull). Severe cases may need to undergo decompressive craniectomy (excision of a part of the cranium).
Complications
Untreated ICP can lead to severe neurological damage and even death.
When to contact a doctor
Contact a doctor as soon as you experience a severe headache along with vomiting.
Systems involved
Ophthalmic, CNS
Organs involved
Eye, brain
