Raised ICP and Hydrocephalus

Question 1

What are the main causes of raised ICP?

Answer 1

Inter-cranial haemorrhage
SOL
Infection (encephalitis/meningitis)
Hydrocephalus 
Cerebral venous thrombosis (blocks drainage via the venous sinuses)
Idiopathic intracranial hypertension

Question 2

List the features in a headache which reflect a raised intercranial pressure?

Answer 2

Onset: nocturnal/starting when waking

Exacerbating: worse on coughing or moving head

Associated symptoms: altered mental state, vomiting, blurred vision.

Combination of headache, vomiting and papilloedema are indicative of chronic raised ICP. Papilloedema takes time to develop not an acute symptom.

Question 3

What are the complications of raised ICP?

Answer 3

Seizures and other focal neurology.

Death from coning.

Question 4

What are the best indicators of raised ICP acutely?

Answer 4

Reduced GCS.
Cushing’s reflex: Hypertension with bradycardia
Pupil: Relevant afferent pupillary defect/dilated pupils