Raised intracranial pressure

Raised intracranial pressure can be caused by:

• head injury
• stroke
• brain infections, such as meningitis, encephalitis, brain abscess
• brain tumours or cancers that come from your brain or have spread from other parts of your body such as your breast, bowel or lungs
• bleeding in your brain, such as from a burst blood vessel or from a tumour 
• idiopathic intracranial hypertension, which is when you have increased pressure around your brain but no cause for this can be found
• build-up of cerebrospinal fluid (CSF) in your brain (hydrocephalus), eg, in babies with spina bifida, or after an illness or injury in older children and adults 
• swelling following brain surgery
• high blood pressure.

Symptoms of raised intracranial pressure often develop gradually and include:

• a headache
• drowsiness
• blurred vision
• temporary loss of vision, eg, for a few seconds at a time which may be triggered by coughing, sneezing or bending down
• confusion
• behaviour changes
• poor memory or restlessness
• seizures or fits
• nausea (feeling sick) or vomiting (being sick)
• altered sensation in parts of your body such as tingling, 'pins and needles' or numbness
• coordination and balance problems
• weakness of your legs or arms.
  
  

Your healthcare provider will take a history and examine you to test your:

• muscle strength
• balance
• eyes and vision
• mental status.

They may request some tests based on your symptoms. This may involve urgent brain scanning, such as a CT scan or an MRI scan, to find out the cause of your raised intracranial pressure. You may also need a lumbar puncture, where a needle is inserted into the lower part of your spine to measure the pressure of the cerebrospinal fluid.

If you have raised intracranial pressure, your healthcare provider will discuss treatment options with you. Treatment depends on what’s caused the raised pressure, such as a brain tumour, stroke, meningitis or head injury.

Sudden increased intracranial pressure is a medical emergency that’s treated in hospital. Treatment may include:

• support to help you breathe
• draining cerebrospinal fluid to reduce pressure in your brain
• medicines to decrease brain swelling
• surgery to remove part of your skull to ease swelling
• treating the cause of your increased intracranial pressure, eg, brain tumour or bleeding in your brain.

Raised intracranial pressure from a brain tumour

If you have raised intracranial pressure from a brain tumour, treatment usually depends on the type of cancer you have and your general health. Before treatment is started, your healthcare provider may ask you about your wishes or whether you have an advance care plan. You may also be admitted to a hospital for treatment and be referred to a palliative care specialist.

Treatment aims to reduce swelling and pressure around your brain. Your doctor may give you medicines to reduce your symptoms and make you feel better. These include:

• steroids, such as dexamethasone or prednisone
• pain relief, which may include opioids
• sedating medications, such as benzodiazepines or opioids
• anticonvulsants (also called anti-seizure medications or ASMs) such as levetiracetam or sodium valproate, if there’s risk of seizures.

You may be offered radiotherapy or surgery depending on the outlook of your underlying condition.

Raised intracranial pressure from hydrocephalus

Hydrocephalus, or excess fluid in the brain, is treated with surgery. If it’s not treated, the increase in pressure will cause brain damage.

Babies who are born with hydrocephalus, (eg, some babies with spina bifida), and children or adults who develop it later, (eg, due to head injury or a brain tumour), usually need prompt treatment to reduce the pressure on their brain. Surgery involves putting in a thin tube called a shunt so that excess cerebrospinal fluid can flow from the brain into another part of the body, usually the tummy, where it gets absorbed into your blood. A less common type of surgery uses an endoscope (a flexible tube with a small camera at the end of it) and involves making a small hole in the floor of the brain so that fluid can drain out.

Some people have ‘normal pressure hydrocephalus’ where there isn’t a significant increase in cerebrospinal fluid pressure. This usually affects older people and can sometimes be treated with a shunt.

Raised intracranial pressure from idiopathic intracranial hypertension

If there’s no obvious cause for the increased pressure around your brain, treatment may include:

• losing weight if you’re overweight – this can reduce your symptoms and may relieve them completely
• stopping any medicine that may be causing your symptoms
• diuretic medicine to remove excess fluid from your body
• medicine to help your body make less cerebrospinal fluid, such as acetazolamide
• steroid medicine to relieve headaches and reduce your risk of vision loss
• surgery, if other treatments don’t work, especially if your vision is getting worse.

If you need surgery, this might involve putting in a shunt to drain fluid from around your brain, or eye surgery to reduce pressure on your optic nerve (the nerve that connects your eye to your brain).

You may not be able to prevent raised intracranial pressure, but there are things you can do to lower your risk of getting the health conditions that can cause it. These conditions include hypertension, stroke, infection and head injury.

Things you can do include:

• regular physical activity
• maintaining a healthy weight
• eating a healthy diet
• taking a falls prevention course if you’re an older adult or have balance problems
• getting recommended vaccines and wash your hands often to reduce your risk of infections
• wearing protective head gear if you’re playing contact sports or riding a horse, bike or motorcycle.
• wearing a seatbelt when you’re driving or travelling
• avoiding taking drugs such as amphetamines/methamphetamine, cocaine, nitrous oxide, MDMA and cannabis.

Sudden increased intracranial pressure is an emergency that needs to be treated urgently to lower the increased pressure around your brain. If it’s not treated, increased intracranial pressure can lead to permanent brain damage or death.

Chronic (long-lasting) increased intracranial pressure (eg, some cases of idiopathic intracranial hypertension), can result in permanent loss of vision. This is because increased pressure around your brain can causing swelling of your optic nerve. Treatment (see above) can be given to reverse and prevent vision loss.

Sara shares her journey with an idiopathic intracranial hypertension (IIH) diagnosis. 

Video: Being diagnosed with idiopathic intracranial hypertension – lived experience kōrero