Symptoms of Increased Intracranial Pressure (ICP)
The most common symptoms of increased intracranial pressure (ICP) include headache, nausea, vomiting, blurred vision, decreased level of consciousness, and papilledema, which can progress to more severe manifestations like pupillary abnormalities, posturing, and respiratory pattern changes if left untreated. 1, 2
Early Signs and Symptoms
Early manifestations of increased ICP include:
- Headache - typically worsens over time and with position changes 1
- Nausea and vomiting - often projectile and not relieved by antiemetics 1
- Decreased level of consciousness - ranging from subtle confusion to drowsiness 1
- Visual disturbances - blurred vision, diplopia, visual field defects 1, 2
- Deterioration in motor function - weakness, hemiparesis 1
- Changes in vital signs - particularly blood pressure and heart rate 1
- Changes in respiratory pattern 1
Late Signs and Symptoms
As ICP continues to rise, more severe manifestations develop:
- Pupillary abnormalities - sluggish or non-reactive pupils, asymmetric pupils 1, 2
- Persistent changes in vital signs - Cushing's triad (hypertension, bradycardia, irregular respiration) 1
- Posturing - decorticate or decerebrate posturing 3
- Respiratory pattern abnormalities - Cheyne-Stokes breathing, ataxic breathing 1
- Altered mental status - progressing to stupor and coma 2, 3
Age-Specific Presentations
Different age groups may present with unique symptoms:
- Infants: increasing head circumference, bulging fontanelles, loss of developmental milestones, irritability 1
- School-age children: poor school performance, fatigue, personality changes, headache 1
- Adults: classic symptoms as described above 1, 2
Special Clinical Scenarios
Certain clinical contexts may present with additional symptoms:
- Cerebellar infarcts/hemorrhages: hydrocephalus and generalized increased ICP 1
- Large hemispheric infarcts/hemorrhages: brain herniation rather than generalized ICP increase 1
- Brain tumors: gradual onset of symptoms that worsen over time 1
- Stroke: sudden onset of focal neurological deficits with ICP symptoms 1
Warning Signs Requiring Immediate Intervention
The following symptoms indicate a medical emergency requiring immediate attention:
- Rapidly worsening visual acuity or visual fields 2
- New or worsening diplopia 2
- Severe intractable headaches 2
- Altered mental status 2, 3
- Pupillary changes 1
- Changes in respiratory pattern 1
Diagnostic Considerations
While symptoms are critical for clinical suspicion, definitive diagnosis of increased ICP requires:
- Invasive ICP monitoring through an external ventricular catheter or intraparenchymal probe 3
- Neuroimaging (MRI or CT) showing mass effect, midline shift, or ventricular compression 1, 2
- Lumbar puncture with opening pressure measurement (when safe to perform) 2, 4
Early recognition of these symptoms is essential for prompt intervention to prevent cerebral hypoperfusion, brain herniation, and potential death from increased ICP 3, 5.