Raised Intracranial Pressure

Question 1

Aetiology of Raised Intracranial Pressure

Answer 1

Space occupying lesion (tumour, abscess, cyst)
Cerebral oedema (trauma, altitude)
Vascular (Haemorrhage)
Infection (meningitis, encephalitis, brain abscess)
Benign intracranial hypertension, hydrocephalus
Status eplipeticus
Malignant hypertension
Idiopathic

Question 2

What are the risk factos for idiopathic Raised Intracranial Pressure

Answer 2

Female
Weight gain
Sleep apnoea
Drugs e.g. tetracycline

Question 3

Symptoms of Raised Intracranial Pressure

Answer 3

Depends on the cause

Generally:
Headache (worse in the morning, bending over or coughing)
Early morning nausea or vomiting 
Transient visual obscuration 
Pulse-synchronous tinnitus 
Photophobia
Retrobulbar pain
Diplopia

Question 4

Signs of Raised Intracranial Pressure on examination

Answer 4

Depends on cause

Papilloedema (optic disc swelling)
Large blind spots with peripheral field constriction/loss and decreased visual acuity 
Relative afferent pupillary defect 
Altered GCS (drowsy, listeless, irritable, oedema)
Pupil changes (constriction -> dilation)

Cushing’s: High BP, bradycardia, irregular breathing

Question 5

Investigations for Raised Intracranial Pressure

Answer 5

Visual field testing: visual field defect, enlarged blinds spots, inferonasal loss
Optic disc photos: papilloedema

MRI: -ve intracranial and infraorbital pathology, empty sella, flattening of the globe
LP: opening pressure >250 mmH2O