Management of increased intracranial pressure (ICP)

In this article, we will discuss the Management of increased intracranial pressure (ICP). So, let’s get started.


1. Treatment of the underlying cause: The ideal treatment of raised intracranial pressure is to find out the cause and treat it accordingly, for example CSF diversion for hydrocephalus, drainage of an abscess, removal of a clot or a tumor.

2. Measures to reduce intracranial pressure: There are some medical and surgical measures to reduce the ICP, which may prove life-saving. generally and any ICP above 25 mmHg needs treatment.

A. General

  • Intubation and hyperventilation are used to lower the ICP in patients with coma and unilateral pupillary changes (herniation) until definite treatment can be instituted.
  • Airway patency to be insured and maintained. Elevate the head by 30 to 45 degree. Avoid neck flexion.
  • Symptomatic treatment with antibiotic, analgesics and anticonvulsants (if convulsions occurs)
  • Adequate hydration by fluids. avoid hypotonic fluids.
  • Catheterization of bladder to avoid straining.

B. Medical treatment: The drugs that reduce the ICP are given below. Sedation and neuromuscular paralysis, if necessary (patient will require endotracheal intubation and mechanical ventilation).

  1. Mannitol (20%) e.g. 100 ml I.V. 4-6 hourly
  2. Glycerol (10%) e.g. 1-2 g/kg over 4 hours
  3. Dexamethasone: It is used in vasogenic ICP. Dose is 10-20 mg/24 hour in divided doses
  4. Furosemide e.g. 20-40 mg I.V.

C. Surgical

  • Ventricular drainage: Lumbar drainage is indicated as an emergency procedure only in benign raised intracranial hypertension.
  • Long-term measures for reduction of elevated intracranial pressure involve shunting procedures that is ventriculoperitoneal shunt, lumbar peritoneal shunt, endoscopic third ventriculostomy and endoscopic stent placement in cerebral aqueduct.
  • Treatment of refractory raised intracranial pressure: High-dose Barbiturates, hemicraniectomy or hypothermia are sometimes used for refractory cases of raised intracranial pressure.

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