Increased intracranial pressure
ICP - raised; Intracranial pressure - raised; Intracranial hypertension; Acute increased intracranial pressure; Sudden increased intracranial pressureIncreased intracranial pressure is a rise in the pressure inside the skull that can result from or cause brain injury.
Causes
Increased intracranial pressure can be due to a rise in pressure of the cerebrospinal fluid. This is the fluid that surrounds the brain and spinal cord. Increase in intracranial pressure can also be due to a rise in pressure within the brain itself. This can be caused by a mass (such as a tumor), bleeding into the brain or fluid around the brain, or swelling within the brain itself.
An increase in intracranial pressure is a serious and life-threatening medical problem. The pressure can damage the brain or spinal cord by pressing on important structures and by restricting blood flow into the brain.
Many conditions can increase intracranial pressure. Common causes include:
- Aneurysm rupture and subarachnoid hemorrhage
Aneurysm
An aneurysm is a weak area in the wall of a blood vessel that causes the blood vessel to bulge or balloon out. When an aneurysm occurs in a blood ve...
ImageRead Article Now Book Mark ArticleSubarachnoid hemorrhage
Subarachnoid hemorrhage is bleeding in the area between the brain and the thin tissues that cover the brain. This area is called the subarachnoid sp...
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- Encephalitis (irritation and swelling, or inflammation of the brain)
Encephalitis
Encephalitis is irritation and swelling (inflammation) of the brain, most often due to infections.
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Head injury
A head injury is any trauma to the scalp, skull, or brain. The injury may be only a minor bump on the skull or a serious brain injury. Head injury c...
ImageRead Article Now Book Mark Article - Hydrocephalus (increased fluid within the brain)
Hydrocephalus
Hydrocephalus is a buildup of fluid inside the skull that leads to brain swelling. Hydrocephalus means "water on the brain. "
ImageRead Article Now Book Mark Article - Hypertensive brain hemorrhage (bleeding in the brain from high blood pressure)
- Intraventricular hemorrhage (bleeding into the fluid-filled areas, or ventricles, inside the brain)
- Meningitis (infection of the membranes covering the brain and spinal cord)
Meningitis
Meningitis is an infection of the membranes covering the brain and spinal cord. This covering is called the meninges.
ImageRead Article Now Book Mark Article - Subdural hematoma (bleeding between the covering of the brain and the surface of the brain)
Subdural hematoma
A subdural hematoma is a collection of blood between the covering of the brain (dura) and the surface of the brain.
ImageRead Article Now Book Mark Article - Epidural hematoma (bleeding between the inside of the skull and the outer covering of the brain)
Epidural hematoma
An epidural hematoma (EDH) is bleeding between the inside of the skull and the outer covering of the brain (called the dura).
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Seizure
Epilepsy is a brain disorder in which a person has repeated seizures over time. Seizures are episodes of uncontrolled and abnormal firing of brain c...
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Stroke
A stroke occurs when blood flow to a part of the brain stops. A stroke is sometimes called a "brain attack. " If blood flow is cut off for longer th...
ImageRead Article Now Book Mark Article - Brain injury following a cardiac arrest
- Clots in the veins of the brain (sinus thrombosis)
Symptoms
Infants:
- Drowsiness
- Separated sutures on the skull
Separated sutures
Separated sutures are abnormally wide spaces in the bony joints of the skull in an infant.
ImageRead Article Now Book Mark Article - Bulging of the soft spot on top of the head (bulging fontanelle)
- Vomiting
Older children and adults:
- Behavior changes
- Decreased alertness
Decreased alertness
Decreased alertness is the most severe state of reduced awareness and is a serious condition. A coma is a state of decreased alertness from which a p...
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Headache
A headache is pain or discomfort in the head, scalp, or neck. Serious causes of headaches are rare. Most people with headaches can feel much better...
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- Nervous system symptoms, including weakness, numbness, eye movement problems, and double vision
- Seizures
Seizures
A seizure is the physical changes in behavior that occurs after an episode of abnormal electrical activity in the brain. The term "seizure" is often ...
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Vomiting
Nausea is feeling an urge to vomit. It is often called "being sick to your stomach. "Vomiting or throwing-up is forcing the contents of the stomach ...
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Exams and Tests
A health care provider will usually make the diagnosis at the patient's bedside in an emergency room or hospital. Primary care doctors may sometimes spot early symptoms of increased intracranial pressure such as headache, seizures, or other nervous system problems.
An MRI or CT scan of the head can usually determine the cause of increased intracranial pressure and confirm the diagnosis.
MRI
A head MRI (magnetic resonance imaging) is an imaging test that uses powerful magnets and radio waves to create pictures of the brain and surrounding...

CT scan
A head computed tomography (CT) scan uses many x-rays to create pictures of the head, including the skull, brain, eye sockets, and sinuses.

Intracranial pressure may be measured during a spinal tap (lumbar puncture). It can also be measured directly by using a device that is drilled through the skull or a tube (catheter) that is inserted into a hollow area in the brain called the ventricle.
Spinal tap
Cerebrospinal fluid (CSF) collection is a test to look at the fluid that surrounds the brain and spinal cord. CSF acts as a cushion, protecting the b...

Device
Intracranial pressure (ICP) monitoring uses a device placed inside the head. The monitor senses the pressure inside the skull and sends measurements...

Treatment
Sudden increased intracranial pressure is an emergency. The person will be treated in the intensive care unit of the hospital. The health care team will measure and monitor the person's neurological and vital signs, including temperature, pulse, breathing rate, and blood pressure.
Treatment may include:
- Breathing support
- Draining of cerebrospinal fluid to lower pressure in the brain
- Medicines to decrease swelling
- Removal of part of the skull, especially in the first 2 days of a stroke that involves brain swelling
If a tumor, hemorrhage, or other problem has caused the increase in intracranial pressure, these problems will be treated.
Outlook (Prognosis)
Sudden increased intracranial pressure is a serious and often life-threatening condition. Prompt treatment results in better outlook.
If the increased pressure pushes on important brain structures and blood vessels, it can lead to serious, permanent problems or even death.
Long-lasting increased intracranial pressure (such as with idiopathic increased intracranial hemorrhage) can result in permanent vision loss.
Prevention
This condition usually cannot be prevented. If you have a persistent headache, blurred vision, changes in your level of alertness, nervous system problems, or seizures, seek medical help right away.
References
Ball JW, Dains JE, Flynn JA, Solomon BS, Stewart RW. Emergency or life-threatening situations. In: Ball JW, Dains JE, Flynn JA, Solomon BS, Stewart RW, eds. Seidel's Guide to Physical Examination. 9th ed. St Louis, MO: Elsevier; 2019:chap 26.
Beaumont A. Physiology of the cerebrospinal fluid and intracranial pressure. In: Winn HR, ed. Youmans and Winn Neurological Surgery. 7th ed. Philadelphia, PA: Elsevier; 2017:chap 52.
O'Reilly G, Cameron P. Neurotrauma. In: Cameron P, Little M, Mitra B, Deasy C, eds. Textbook of Adult Emergency Medicine. 5th ed. Philadelphia, PA: Elsevier; 2020:chap 3.2.
Subdural hematoma - illustration
Subdural hematoma develops when blood vessels that are located between the membranes covering the brain (the meninges) leak blood after an injury to the head. This is a serious condition since the increase in intracranial pressure can cause damage to brain tissue and loss of brain function.
Subdural hematoma
illustration
Subdural hematoma - illustration
Subdural hematoma develops when blood vessels that are located between the membranes covering the brain (the meninges) leak blood after an injury to the head. This is a serious condition since the increase in intracranial pressure can cause damage to brain tissue and loss of brain function.
Subdural hematoma
illustration
Review Date: 5/4/2021
Reviewed By: Joseph V. Campellone, MD, Department of Neurology, Cooper Medical School at Rowan University, Camden, NJ. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.