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Intracranial hypertension

Intracranial hypertension, commonly abbreviated IH, IICP or raised intracranial pressure (ICP), is elevation of the pressure in the cranium greater than 20 cmH2O.

ICP is normally 7–15 mm Hg; at 20–25 mm Hg, the upper limit of normal, treatment to reduce ICP may be needed.

Cerebral venous sinus stenosis has been reported in up to 90% of patients with IIH.

Repeat studies after normalization of the intracranial pressure demonstrated normalization of this finding.

The cerebral sinus narrowing might be a consequence of the increased intracranial pressure. However, venous sinus narrowing/thrombosis could cause increased intracranial pressure as well. This situation could represent the chicken or egg debate as to which occurs first 1).


Idiopathic intracranial hypertension

Patients suffering from uncontrollable intracranial hypertension due to posttraumatic brain swelling.

see Intracranial Hypertension in Children.


An MRI or CT scan of the head can usually determine the cause of increased intracranial pressure and confirm the diagnosis.

Intracranial pressure may be measured during a spinal tap (lumbar puncture). It can also be measured directly by using a device that is drilled through the skull or a tube (catheter) that is inserted into a hollow area in the brain called the ventricle.

see Intracranial pressure monitoring.

see Noninvasive intracranial pressure monitoring.

The diagnosis of raised intracranial pressure (ICP) is important in many critically ill patients. The optic nerve sheath is contiguous with the subarachnoid space; thus, an increase in ICP results in a corresponding increase in the optic nerve sheath diameter.

Ocular sonography shows good diagnostic test accuracy for detecting raised ICP compared to CT: specifically, high sensitivity for ruling out raised ICP in a low-risk group and high specificity for ruling in raised ICP in a high-risk group. This noninvasive point-of-care method could lead to rapid interventions for raised ICP, assist centers without CT, and monitor patients during transport or as part of a protocol to reduce CT use 2).

see Optic nerve sheath diameter ultrasonography.


Intracranial hypertension is the largest cause of death in young patients with severe traumatic brain injury 3).


Autonomic impairment after acute traumatic brain injury has been associated independently with both increased morbidity and mortality. Links between autonomic impairment and increased intracranial pressure or impaired cerebral autoregulation have been described as well. However, relationships between autonomic impairment, intracranial pressure, impaired cerebral autoregulation, and outcome remain poorly explored.

If intracranial pressure gets too high, it can lead to deadly brain herniation, in which parts of the brain are squeezed past structures in the skull.


Shaw GY, Million SK. Benign intracranial hypertension: a diagnostic dilemma. Case Rep Otolaryngol. 2012;2012:814696.
Ohle R, McIsaac SM, Woo MY, Perry JJ. Sonography of the Optic Nerve Sheath Diameter for Detection of Raised Intracranial Pressure Compared to Computed Tomography: A Systematic Review and Meta-analysis. J Ultrasound Med. 2015 Jul;34(7):1285-94. doi: 10.7863/ultra.34.7.1285. Review. PubMed PMID: 26112632.
Alvis-Miranda H, Castellar-Leones SM, Moscote-Salazar LR. Decompressive Craniectomy and Traumatic Brain Injury: A Review. Bull Emerg Trauma. 2013 Apr;1(2):60-8. Review. PubMed PMID: 27162826; PubMed Central PMCID: PMC4771225.
intracranial_hypertension.txt · Last modified: 2018/11/14 22:36 by administrador