Clinical Features of Raised Intracranial Pressure
| Feature | Comment |
|---|---|
| Headache | Classically wakes the patient from sleep in the early hours of the morning, due to recumbency and the vasodilating effect of hypercapnia while asleep. Also exacerbated by lying down or bending over, coughing, sneezing or laughing. |
| Vomiting | Vomiting is a late feature of raised ICP. It typically occurs after waking, and is associated with morning headache. |
| Visual symptoms | These include a deterioration in visual acuity, field loss, blurring of vision and visual obscurations with episodic darkening of vision. |
| Reduced conscious level | As ICP increases, there is a progressive fall in conscious level (which should be assessed by the Glasgow coma scale score) due to caudal displacement of the diencephalon and midbrain. |
| Seizures | Seizures are extremely deleterious in raised ICP and should be treated aggressively. Prophylaxis is often appropriate, especially in intracranial infection – seek specialist advice. |
| Papilloedema | Optic nerve head swelling suggests relatively long-standing raised ICP, as well as a threat to vision, and mandates urgent investigation. Retinal haemorrhages may also be present. |
| Focal neurological deficits | These include extraocular muscle palsy, facial nerve palsy, limb weakness or numbness, upper motor neuron signs such as extensor plantar response, ataxia, dysphasia, dysarthria. An abnormal neurological examination in the context of a suggestive history requires urgent investigation. |