Intracranial Pressure Management

ICP Management

Background

Intracranial pressure (ICP) is the pressure exerted by fluids in the cranial vault, composed of the brain tissue, blood, and cerebrospinal fluid (CSF). When the volume of any of the three components rises, the intracranial pressure increases, leading to a decrease in blood flow to the brain. Treatment is typically necessary when ICP exceeds 20 mmHg. 

Causes and Complications of Increased ICP

Increased ICP can result from brain injuries such as stroke or a ruptured brain aneurysm, as well as underlying conditions like brain tumor, high blood pressure, hydrocephalus (excess CSF buildup) and meningitis (infection of the membrane around the brain and spinal cord). If left untreated, Increased ICP may result in seizures, stroke, neurological damage, or even death. 

Symptoms of Increased ICP 

• A persisting headache that is often worse in the morning

• Temporary loss of vision or blurred vision

• Vomiting

• Confusion and change of consciousness

• Shallow breathing

• Hearing pulsing noise within the ears

• Problems with co-ordination and balance 

ICP Diagnosis, Management, and monitoring

Medical professionals will first review patients’ medical history, then conduct a physical exam and determine if further examination is required. Specific exams may include: 

• Nervous system examination - Tests balance, senses, and mental status

• Spinal tap - Measures the pressure of the spinal fluid

• CT scan - Scanning detailed X-ray images of the head area

• MRI scan - Uses a large magnet to generate detailed images of the tissues in the body

Management of ICP  dependents on the underlying cause. Some methods of treatment can include elevating the head of the bed to reduce intracranial pressure, taking medicine to reduce swelling, and draining excess blood or CSF around the brain. 

Surgery may be considered if ICP does not decrease, especially if the patient’s vision gets worse. One option is decompressive craniectomy, where a part of the skull is removed to reduce swelling and therefore relieve pressure. Additionally, pressure can be alleviated by the removal of intracerebral hemorrhages such as epidural and subdural hematomas. 

Works Cited

Brain & Spine Group. “Intracranial Pressure (ICP) Management.” YouTube, 22 July 2020, https://www.youtube.com/watch?v=QEaDN1kskR8. Accessed 2 February 2025.

Freeman, W. David. "Management of Intracranial Pressure." CONTINUUM: Lifelong Learning in Neurology, vol. 21, Oct. 2015, pp. 1299-323, https://doi.org/

     10.1212/con.0000000000000235.

“Increased Intracranial Pressure (ICP): Symptoms & Treatment.” Cleveland Clinic, 20 June 2024, https://my.clevelandclinic.org/health/diseases/increased-intracranial-pressure-icp. Accessed 2 February 2025.

“Intracranial hypertension.” NHS, https://www.nhs.uk/conditions/intracranial-hypertension/. Accessed 2 February 2025.