Raised intracranial pressure (ICP)

• Headache gradually increasing in severity over time
• Persistent headache classically worse in morning
• Headache often worse on coughing, sneezing and bending over
• Vomiting (commonly without nausea)
• Visual disturbance
• Dizziness
• Personality change
• Seizures.

Diagnosis is usually based on the history. Signs are often late but can include:

• raised blood pressure
• altered level of consciousness
• ocular palsies
• papilloedema.

• Urgent CT Brain may be necessary.
• For patients with cancer, raised ICP may be caused by the cancer or a bleed into or around the tumour
  • Consider a trial of corticosteroids with gastroprotection (usually proton pump inhibitor),
  • †Dexamethasone 8mg to 16mg orally (or IV) immediately and subsequently †Dexamethasone 4mg to 8mg twice daily orally (second dose before 2pm if possible). Discontinue promptly if no benefit and reduce gradually in responders.
  • Raise the head of the patient’s bed
  • If intracranial bleed suspected stop anticoagulants
  • Symptom relief with analgesia and anti-emetics (†ondansetron 4mg twice a day can be effective in patients with raised ICP)
  • Referral to oncology is important to understand the implications for the patient’s prognosis, and whether disease-modifying therapy would be offered
  • Consider referral to neurosurgery.