Elevated intracranial pressure (ICP) in children
- Robert C Tasker, MBBS, MD
Robert C Tasker, MBBS, MD
- Professor of Neurology and Anaesthesia (Pediatrics)
- Harvard Medical School
- Section Editors
- Susan B Torrey, MD
Susan B Torrey, MD
- Section Editor — Pediatric Resuscitation; Pediatric Trauma
- Director, Division of Pediatric Emergency Medicine
- Associate Professor of Emergency Medicine and Pediatrics (Clinical)
- NYU School of Medicine
- Marc C Patterson, MD, FRACP
Marc C Patterson, MD, FRACP
- Section Editor — Pediatric Neurology
- Professor of Neurology, Pediatrics, and Medical Genetics
- Chair, Division of Child and Adolescent Neurology
- Mayo Clinic College of Medicine
- Adrienne G Randolph, MD, MSc
Adrienne G Randolph, MD, MSc
- Section Editor — Pediatric Critical Care Medicine
- Professor of Anaesthesia and Pediatrics
- Harvard Medical School
- Deputy Editor
- James F Wiley, II, MD, MPH
James F Wiley, II, MD, MPH
- Senior Deputy Editor — Adult and Pediatric Emergency Medicine
- Senior Deputy Editor — Primary Care Sports Medicine (Adolescents and Adults)
- Professor of Pediatrics and Emergency Medicine/Traumatology
- University of Connecticut School of Medicine
Elevated intracranial pressure (ICP) is a potentially devastating complication of neurologic injury. In children, increased ICP is most often a complication of traumatic brain injury; it may also occur in children who have hydrocephalus, brain tumors, or intracranial infections (table 1). Successful management of children with elevated ICP requires prompt recognition and therapy directed at both reducing ICP and reversing its underlying cause. Early recognition of elevated ICP can prevent neurologic sequelae and/or death.
The evaluation and management of children with elevated ICP will be reviewed here. The initial management of children with severe traumatic brain injury and elevated ICP in adults are discussed separately. (See "Initial approach to severe traumatic brain injury in children" and "Evaluation and management of elevated intracranial pressure in adults".)
The intracranial compartment is protected by the skull, a rigid structure with a fixed internal volume; the intracranial contents include (by volume) :
●Brain parenchyma – 80 percent
●Cerebrospinal fluid (CSF) – 10 percent
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- Cerebral blood flow
- - Autoregulation
- - CPP
- Cerebral edema
- Effects of trauma
- Brain herniation syndromes
- - Herniation
- INITIAL STABILIZATION
- Lumbar puncture
- General measures
- Specific medical measures
- - Mannitol
- - Hypertonic saline
- - Hyperventilation
- - CSF drainage
- - Barbiturate coma
- - Corticosteroids
- EXPERIMENTAL THERAPIES
- CONTRAINDICATED THERAPIES
- SUMMARY AND RECOMMENDATIONS