Raised Intracranial Pressure (ICP)

Last Updated on August 19, 2026

Introduction

Causes

Clinical Features

Presentation

• Altered mental status e.g. due to acute massive haemorrhagic stroke / intracranial bleed due to trauma etc.

Symptoms

• Headache
• Vomiting

Signs

• Cushing ’s response: bradycardia + elevated BP
• Altered GCS / Drowsiness
• Irritability
• Pupil changes

Investigations

Imaging

CT brain
• Effacement of the ventricles, basal cisterns and other CSF spaces
• Loss of grey-white matter differentiation
• Brain herniation

Reference: Radiopedia

Management

Aims
• To reduce ICP and to maintain CPP
• To treat underlying causes

Immediate management

• Elevate head of bed to 30 – 40°
• If hypotension, to correct hypotension , aim MAP >90 mmHg
• If intubated, hyperventilate to aim pCO2 to 26 – 30 mmHg

• Consider sedation, hypothermia
• Arrange for CT brain

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Reference: Oxford Handbook of Clinical Medicine 10th ED

Definitive management

• Depends on the underlying cause
• Refer Neurosurgery for craniotomy / Burr hole e.g. in intracranial haematoma

References

1. Increased Intracranial Pressure – StatPearls – NCBI Bookshelf (nih.gov)