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Elevated intracranial pressure (ICP) in children: Clinical manifestations and diagnosis

Robert C Tasker, MBBS, MD
Section Editors
Susan B Torrey, MD
Marc C Patterson, MD, FRACP
Adrienne G Randolph, MD, MSc
Deputy Editor
James F Wiley, II, MD, MPH


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 "Severe traumatic brain injury in children: Initial evaluation and management".)


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 [4]. Occasional transient elevations may occur with physiologic events, including sneezing, coughing, or Valsalva maneuvers. However, sustained elevations above this pressure are abnormal [5].

The intracranial compartment is protected by the skull, a rigid structure with a fixed internal volume; the intracranial contents include (by volume) [6]:

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Literature review current through: Nov 2017. | This topic last updated: Mar 16, 2017.
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