Around 5.48 million people are believed to experience severe traumatic brain injury annually. That’s roughly 73 cases per 100,000 people. This kind of injury can lead to rising pressure in the skull, resulting in increased intracranial pressure (ICP). (1)
In the short term, ICP can cause a headache. But, it can also further injure the spinal cord or brain. ICP is a medical emergency. This neurologic complication requires immediate medical attention. But, very few people might be aware of its symptoms. That’s why it’s critical to spot the complications and seek expert help. Here is how ICP affects the body. (2)
What Is Increased ICP?
Increased ICP (intracranial pressure) is produced by the pressure and volume of three segments of the cranial vault, also known as the skull vault. These are the blood, brain tissue, and cerebrospinal fluid (CSF). These components are typically in equilibrium, with normal ICP between 10 to 20 mm Hg.
Since there is only so much space for expansion in the skull, a spike in any of these components triggers a change in ICP. As ICP increases, the autoregulatory mechanism of the brain tries to keep the blood flow in check and prevent any further tissue damage.
It does that by allowing the brain to change the diameter of its blood vessels. Typically, cerebral perfusion pressure is 70-100 mm Hg. However, when ICP increases substantially, the brain’s mechanism becomes overwhelmed, and the perfusion pressure rises to over 100 mm Hg. Or it can fall below 50 mm Hg. (3)
What Can Cause Intracranial Pressure?
Short-term ICP is dangerous. The spiking pressure from a stroke, elevated blood pressure, aneurysm, brain infection, or other neurological complications can trigger a headache and a range of different symptoms.
The increased intracranial pressure causes are classified according to the intracerebral factors triggering these pressures. Such as the mass effect, increased brain volume increased and decreased cerebrospinal fluid and other causes. (4)
In other words, the following issues can lead to a rising ICP:
– Brain swelling
– Head or brain injury
– Brain bleed or hemorrhage
– Brain tumor
– Elevated blood pressure
– Hydrocephalus (cerebrospinal fluid built-up)
– Infections (i.e., meningitis or encephalitis)
– Intraparenchymal hematoma (blood pooling in certain areas of the brain) (5)
Any of these conditions are more than capable of altering the relationship between the pressure and intracranial volume. Spiking ICP from these causes reduces cerebral perfusion, which, in turn, can lead to cell death and ischemia.
What Is One of the Earliest Signs of Increased Intracranial Pressure?
People want to know what is the first sign of increased intracranial pressure. When ICP increases, the patient’s health state becomes substantially worse. One of the earliest signs is a change in mental status. The patient can feel restless, confused, and highly disoriented.
Other signs of increased intracranial pressure include:
– Purposeless movements
– Respiratory distress
– Change in respiratory patterns
– Changes in pupillary response
– Constant headaches that get progressively worse with strains or movement
– Decreased pulse rates
– Losing consciousness
– Vomiting and nausea
– Weakness in one side of the body or one extremity
– Increased body temperature and blood pressure
When it comes to this particular neurological complication, it’s essential to distinguish the early vs. late signs of increased ICP. Changes in respiratory pattern, pulse, and blood pressure are considered late signs. They may also be related to ischemia or brain stem distortion. (6)
How Long Can Intracranial Pressure Last?
Focal neurological deficits, like impairments in brain function, spinal cord, or nerve function and reduced mental status, often start to improve in a couple of hours. The elevated ICP subsides in the next 2 to 5 days. In some patients, it returns to normal during this time period.
But, the management of increased intracranial pressure will vary from person to person. The go-to treatment is 4mg of IV dexamethasone every 6 hours. However, steroids can be used for other neurosurgical complications, like traumatic brain injury (TBI) or spontaneous intracerebral hemorrhage. In some trials, steroids for TBI have a detrimental impact. (7)
How Is Increased ICP Diagnosed?
Identifying a short-term or long-term problem comes down to proper diagnosis. If a person is experiencing any underlying symptoms, it’s critical to contact a specialist. Doctors measure the ICP in mm/Hg and evaluate whatever is causing the problem.
They will ask if the patient has:
– Been previously diagnosed with a brain tumor.
– Experienced a traumatic blow to the head.
Then, the doctor might suggest a CT scan, spinal tap, and neurological exam depending on what the patient went through. CT scans are a practical testing method that offers images of the brain and head to give doctors a better perspective of what is happening inside the body.
The spinal tap will measure the cerebrospinal fluid pressure, which can be a clear indicator of increased ICP. If the patient appears disoriented, then a neurological exam is necessary. It’s meant to test the patient’s current mental state, balance, and overall senses.
If there is something wrong with the brain tissue, and further analysis is necessary, the specialist can suggest an MRI scan. This will provide experts with a clear overview of the patient’s brain tissue.
How Is Increased ICP Treated?
Whether the complications are causing long or short-term problems, healthcare experts will immediately work to curb the pressure inside the skull. This can decrease the risk of brain damage. Then, they will start working on treating the core of the problem. That includes:
– Using a shunt to drain the extra cerebrospinal fluid.
– Providing the patient with necessary medication to curb the brain swelling.
– Relying on surgery if necessary to take out a tiny section of the skull and alleviate the pressure.
Some of the most typically used meds for brain swelling are hypertonic saline and mannitol. But, it’s not uncommon for specialists to give the patient a sedative to reduce their blood pressure and anxiety. In some instances, patients might need additional breathing support.
To ensure that the patient’s recovery is on the right track, the doctor will monitor their increased intracranial pressure vital signs throughout the treatment. For those wondering how to lower intracranial pressure at home, it’s essential not to take matters into your own hands. Consult a specialist and get adequate treatment. This is a medical emergency that could turn into a potentially dangerous problem. (8)
A sudden spike in ICP is dangerous and potentially life-threatening. However, people can recognize the issue and seek adequate treatment from the signs and symptoms listed here. Depending on what’s causing the problem, doctors will select the best possible management strategy. Many patients respond well to the treatment and medication they receive. With proper expert help, those affected can make a full recovery.