What are early signs of ICP?

Answer 1

The most sensitive--and generally the earliest--indicator of deteriorating neurologic status is level of consciousness (LOC), including the patient's awareness of surroundings and self. Even a slight alteration in LOC can indicate brain dysfunction of increased intracranial pressure. And the longer the dysfunction lasts, the greater the chance of permanent injury.

The earliest signs and symptoms of decreasing LOC are also the most subtle. The patient may become lethargic, talkative or quiet, or restless and irritable. He may have trouble remembering things, experience a change in personality, or complain of nausea and vomiting. Symptoms may progress to confusion or diminished responsiveness. The patient may even develop hemiparesis or new-onset seizures.

Besides changes in LOC, other signs that may indicate increased ICP are an altered respiratory pattern, unequal pupils, and sluggish pupillary response to light (early signs); fixed, dilated pupils; decorticate or decerebrate posturing; loss of gag reflex; loss of corneal reflex; and bradycardia (late signs).

Another late sign of increased ICP is a combination of: increased systolic blood pressure, widened pulse pressure, and slowed heart rate. Irregular respiratory patterns may develop, and the patient's temperature may rise.

A breakdown of symptoms:

Infants:

• Drowsiness
• Separated sutures on the skull
• Bulging of the soft spot on top of the head (bulging fontanelle)
• Vomiting

Older children and adults:

• Behavior changes
• Decreased consciousness
• Headache
• Lethargy
• Neurological symptoms, including weakness, numbness, eye movement problems, and double vision
• Seizures
• Vomiting