Increased Intracranial Pressure (ICP): Symptoms, Causes and Treatment

Overview

Most individuals experience headaches at least once in life. But while most headaches respond to over-the-counter medication or a long nap, not all headaches are to be taken lightly. Some headaches may indicate severe health conditions such as increased intracranial pressure (ICP). It is a medical emergency and needs immediate attention. 

Intracranial pressure increases in and around the brain due to increased fluid, tumour, or trauma. If not treated immediately can cause brain injury, stroke, seizure, and coma. The blog explains intracranial pressure, its symptoms, causes, and various treatment options. 

What is raised intracranial pressure?

A brain injury or other condition can lead to growing pressure inside the skull. Such a dangerous condition is known as increased Intracranial Pressure (ICP) and can cause a headache. The pressure also further injures your brain or spinal cord. Increased and severe headache is the first sign of intracranial pressure.

It is a fatal and life-threatening situation that needs prompt medical attention. With timely treatment, the person can make a complete recovery. 

What are the symptoms of high intracranial pressure?

The symptoms of intracranial pressure vary between patients. Age is also significant when it comes to experiencing the symptoms. The common signs of ICP may also be similar to other health conditions. Therefore, it is essential to contact the healthcare provider if a person experiences any of the following common symptoms:

Symptoms in adults

• Unresponsive pupils to light
• Sudden and excruciating headaches that worsen over time
• Behavioural changes
• Lack of alertness
• Sleepiness
• Weakness in the muscles
• Trouble speaking and moving
• Vomiting
• Blurred vision
• Confusion

Symptoms in infants

The symptoms in infants are similar to that of adults. However, if infants experience high intracranial pressure, the shape of the head may be affected as infants have soft plates in their skull . The intracranial pressure may cause the skull sutures and the soft palates to move apart, causing the soft spot on top of the head, known as fontanel, bulge out. 

The common symptoms of increased intracranial pressure are as follows: 

• Headaches
• Nausea and Vomiting
• High blood pressure
• Reduces mental abilities
• Confusion
• Shallow breathing
• Seizures
• Loss of consciousness
• Coma
• Unresponsive pupils to changes in light

If all mentioned symptoms occur simultaneously, a red flag indicates increased intracranial pressure, and the patient needs immediate medical care. 

It is known as Cushing’s Triad when three symptoms occur simultaneously and need immediate medical care. These symptoms are as follows: 

• Irregular breathing
• Increased gap between systolic and diastolic blood pressure
• Decreased heart rate

It is vital to note that increased ICP can also indicate other severe and fatal health conditions, such as stroke, brain tumour, or a recent head injury. 

What are the causes of high intracranial pressure?

The primary cause of increased intracranial pressure is an injury to the head or the skull. The head injury results in bleeding and swelling inside the skull, thus harming the spinal column and the brain tissues.

Many conditions may increase intracranial pressure. Common causes include:

• Aneurysm rupture and subarachnoid haemorrhage
• Head injury 
• Brain tumor
• Stroke
• Seizure
• Encephalitis (swelling and irritation, or inflammation of the brain)
• Brain injury following a cardiac arrest
• Intraventricular haemorrhage (bleeding into the fluid-filled areas, or ventricles, inside brain)
• Hypertensive brain haemorrhage (bleeding in brain from high blood pressure)
• Subdural hematoma (bleeding between the covering of brain and the surface of brain)
• Meningitis (infection of the membranes covering brain & spinal cord)
• Sinus thrombosis (clots in the veins of the brain)
• Epidural hematoma (bleeding between inside of the skull and outer covering of the brain)
• Hydrocephalus (increased fluid within the brain)

In infants, increased intracranial pressure may also result from child abuse. For example, a person vigorously shakes a baby or an infant, causing brain injury. It is known as a shaken baby syndrome. A source estimates that nearly 3000 children in the US suffer from shaken baby syndrome annually. 

When to seek medical help?

If a person has recently suffered a head injury or shows signs of intracranial pressure, they should immediately consult their healthcare provider or visit the nearest emergency care unit. 

 Request an appointment at Apollo Hospitals          

How is high intracranial pressure diagnosed?

Before prescribing other tests, the doctor may ask for the patient’s medical history and conduct a physical examination to check the senses, balance, and mental status. The patient should also provide the doctor with the list of medications or supplements they are consuming. In a physical examination, the doctor also checks for vitals, blood pressure, eye check,  and checks for any recent head injury. The following are some of the additional tests prescribed by the physician to diagnose the condition accurately:

• Spinal tap or lumbar puncture: In this procedure, the doctor inserts a needle in the spinal cord to measure intracranial pressure.
• CT scan or MRI: It creates a series of detailed cross-sectional x-ray images of the head and the brain. These shows subtle brain tissue changes, tumour, brain injury, or conditions, such as idiopathic intracranial hypertension. 

A severe increase in intracranial pressure may lead to critical illness. In such cases, doctors place an invasive intracranial monitoring tool to provide direct reading with the help of a catheter, bolt, or sensor placed inside the skull. 

What are the various treatment options for raised intracranial pressure?

Relieving pressure from the brain or the spinal cord is the primary goal of the treatment. The various treatment options include the following:

• Medicines: Certain medications reduce pressure. If there is a blood clot, the drug can dissolve it. Medicines such as mannitol and hypertonic saline lower blood pressure, sedation reduces anxiety and neurological responses, and inducing hypothermia lowers the overall body temperature. 
• Draining fluid: The doctor may surgically place an external ventricular drain device (EVD). In this procedure, the neurologist shunts the brain and other body parts to drain the excess fluid and redirect it to the abdomen. 
• Surgery: In some instances, the neurologist may perform surgery to relieve the pressure inside the brain. The doctor performs the surgery to stop the bleeding, repair an injury, or remove a tumour. They may also perform craniotomy – a procedure to remove a part of the skull to ease swelling.

Once the pressure is reduced, the next step is finding the cause of increased intracranial pressure. Therefore, resolving the root cause prevents the pressure from worsening. The sooner the patient receives medical treatment, the lower the risk of brain damage. Increased intracranial pressure is a medical emergency that needs immediate attention.

What are the complications of raised intracranial pressure?

The following are the complications of intracranial pressure:

• Seizures
• Stroke
• Neurological damage
• Coma 
• death

Conclusion

As mentioned earlier, a sudden increase in intracranial pressure is a medical emergency that needs immediate medical attention. Failure to receive proper medical care can be life-threatening and fatal. With timely treatment, the patient responds well and can make a recovery as well.

Frequently Asked Questions (FAQs)

Can medications cause increased ICP?

Apart from injuries and health conditions, medications also cause an increase in intracranial pressure. These medications include amiodarone, chlordecone, withdrawal from systemic corticosteroids, cyclosporine, recombinant growth hormones, leuprolide, levothyroxine, lithium carbonate, nalidixic acid, sulfonamide antibiotics, tetracycline antibiotics, isotretinoin, vitamin A supplements, retinoic acids, and some other oral contraceptives.

How is ICP prevented?

Intracranial pressure cannot be completely prevented, but one can prevent head injury. It is best to wear protective gear while riding a bike, play high-contact sports, wear seat belts while driving a car and keep the floors dry to avoid falling.