A Review of the Clinical Presentation, Causes, and Diagnostic Evaluation of Increased Intracranial Pressure in the Emergency Department
Increased intracranial pressure (ICP) is encountered in numerous traumatic and non-traumatic medical situations, and it requires immediate recognition and attention. Clinically, ICP typically presents with a headache that is most severe in the morning, aggravated by Valsalva-like maneuvers, and asso...
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eScholarship Publishing, University of California
2024-09-01
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| Series: | Western Journal of Emergency Medicine |
| Online Access: | https://escholarship.org/uc/item/2gx9w92h |
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| author | Cristiana Olaru Sam Langberg Nicole Streiff McCoin |
| author_facet | Cristiana Olaru Sam Langberg Nicole Streiff McCoin |
| author_sort | Cristiana Olaru |
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| description | Increased intracranial pressure (ICP) is encountered in numerous traumatic and non-traumatic medical situations, and it requires immediate recognition and attention. Clinically, ICP typically presents with a headache that is most severe in the morning, aggravated by Valsalva-like maneuvers, and associated with nausea or vomiting. Papilledema is a well-recognized sign of increased ICP; however, emergency physicians often find it difficult to visualize the optic disc using ophthalmoscopy or to accurately interpret digital fundus photographs when using a non-mydriatic retinal camera. Emergency ultrasound can evaluate the optic nerve sheath diameter (ONSD) and optic disc elevation to determine whether increased ICP is present, however, the studies have been small with different definitions and measurements of the ONSD. The ONSD threshold values for increased ICP have been reported anywhere from 4.8 to 6.3 millimeters. Neuroimaging is the next step in the evaluation of patients with papilledema or high clinical suspicion of increased ICP, as it can identify most structural causes or typical radiological patterns of increased ICP. Neuroradiographic signs of increased ICP can be helpful in suggesting idiopathic intracranial hypertension (IIH), especially when papilledema is absent. Patients with papilledema and normal neuroimaging may undergo lumbar puncture as part of their clinical workup. The cerebrospinal fluid (CSF) opening pressure remains one of the most important investigations to establish the diagnosis of IIH. A CSF evaluation is also required to exclude other etiologies of elevated ICP such as infectious, inflammatory, and neoplastic meningitis. Invasive ICP measurement remains the standard to measure and monitor this condition. |
| format | Article |
| id | doaj-art-02292b506bf14ba99e13ea09894a0aa6 |
| institution | Kabale University |
| issn | 1936-900X 1936-9018 |
| language | English |
| publishDate | 2024-09-01 |
| publisher | eScholarship Publishing, University of California |
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| series | Western Journal of Emergency Medicine |
| spelling | doaj-art-02292b506bf14ba99e13ea09894a0aa62024-12-03T16:58:28ZengeScholarship Publishing, University of CaliforniaWestern Journal of Emergency Medicine1936-900X1936-90182024-09-012561003101010.5811/westjem.1850018500A Review of the Clinical Presentation, Causes, and Diagnostic Evaluation of Increased Intracranial Pressure in the Emergency DepartmentCristiana Olaru0Sam Langberg1Nicole Streiff McCoin2Ochsner Health, Department of Emergency Medicine, New Orleans, LouisianaOchsner Health, Department of Emergency Medicine, New Orleans, LouisianaOchsner Health, Department of Emergency Medicine, New Orleans, LouisianaIncreased intracranial pressure (ICP) is encountered in numerous traumatic and non-traumatic medical situations, and it requires immediate recognition and attention. Clinically, ICP typically presents with a headache that is most severe in the morning, aggravated by Valsalva-like maneuvers, and associated with nausea or vomiting. Papilledema is a well-recognized sign of increased ICP; however, emergency physicians often find it difficult to visualize the optic disc using ophthalmoscopy or to accurately interpret digital fundus photographs when using a non-mydriatic retinal camera. Emergency ultrasound can evaluate the optic nerve sheath diameter (ONSD) and optic disc elevation to determine whether increased ICP is present, however, the studies have been small with different definitions and measurements of the ONSD. The ONSD threshold values for increased ICP have been reported anywhere from 4.8 to 6.3 millimeters. Neuroimaging is the next step in the evaluation of patients with papilledema or high clinical suspicion of increased ICP, as it can identify most structural causes or typical radiological patterns of increased ICP. Neuroradiographic signs of increased ICP can be helpful in suggesting idiopathic intracranial hypertension (IIH), especially when papilledema is absent. Patients with papilledema and normal neuroimaging may undergo lumbar puncture as part of their clinical workup. The cerebrospinal fluid (CSF) opening pressure remains one of the most important investigations to establish the diagnosis of IIH. A CSF evaluation is also required to exclude other etiologies of elevated ICP such as infectious, inflammatory, and neoplastic meningitis. Invasive ICP measurement remains the standard to measure and monitor this condition.https://escholarship.org/uc/item/2gx9w92h |
| spellingShingle | Cristiana Olaru Sam Langberg Nicole Streiff McCoin A Review of the Clinical Presentation, Causes, and Diagnostic Evaluation of Increased Intracranial Pressure in the Emergency Department Western Journal of Emergency Medicine |
| title | A Review of the Clinical Presentation, Causes, and Diagnostic Evaluation of Increased Intracranial Pressure in the Emergency Department |
| title_full | A Review of the Clinical Presentation, Causes, and Diagnostic Evaluation of Increased Intracranial Pressure in the Emergency Department |
| title_fullStr | A Review of the Clinical Presentation, Causes, and Diagnostic Evaluation of Increased Intracranial Pressure in the Emergency Department |
| title_full_unstemmed | A Review of the Clinical Presentation, Causes, and Diagnostic Evaluation of Increased Intracranial Pressure in the Emergency Department |
| title_short | A Review of the Clinical Presentation, Causes, and Diagnostic Evaluation of Increased Intracranial Pressure in the Emergency Department |
| title_sort | review of the clinical presentation causes and diagnostic evaluation of increased intracranial pressure in the emergency department |
| url | https://escholarship.org/uc/item/2gx9w92h |
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