Elevated intracranial pressure (ICP) in children: Clinical manifestations and diagnosis
- 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)
- Clinical Professor of Pediatrics and Emergency Medicine/Traumatology
- University of Connecticut School of Medicine
The clinical manifestations and diagnosis of elevated ICP in children will be reviewed here.
The management of elevated ICP in children, the evaluation of stupor and coma in children, and initial management of children with severe traumatic brain injury are discussed separately. (See "Elevated intracranial pressure (ICP) in children: Management" and "Evaluation of stupor and coma in children" and "Initial approach to severe traumatic brain injury in children".)
Elevated 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, intracranial infections, hepatic encephalopathy, or impaired central nervous system venous outflow (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 death.
Intracranial pressure — The range of normal cerebrospinal fluid (CSF) pressure in children (10th to 90th percentile) at the time of lumbar puncture is 12 to 28 cmH2O (9 to 21 mmHg) [1-3]. Measured ICP >20 mmHg (27 cmH2O) for longer than five minutes with signs or symptoms is generally regarded as the threshold for treatment . Occasional transient elevations may occur with physiologic events, including sneezing, coughing, or Valsalva maneuvers. However, sustained elevations above this pressure are abnormal.
The intracranial compartment is protected by the skull, a rigid structure with a fixed internal volume; the intracranial contents include (by volume) :
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- Intracranial pressure
- Cerebral perfusion pressure
- Cerebral blood flow
- Cerebral edema
- Brain herniation syndromes
- CLINICAL MANIFESTATIONS
- Patient age
- Acutely elevated ICP
- Subacutely or chronically elevated ICP
- Noninvasive detection of elevated ICP
- - Computed tomography
- - Magnetic resonance imaging
- - Detection of papilledema
- - Ocular ultrasound
- Invasive measurement of ICP
- Ancillary studies
- - Laboratory studies
- - Lumbar puncture
- - Electroencephalogram
- DIFFERENTIAL DIAGNOSIS
- Acute intracranial hypertension
- Chronic intracranial hypertension