Raised intracranial pressure

(This was from an article in an old BMJ; I read it while doing some catching up.)


  • Headache: usually worsens over weeks, but sometimes over hours or days. Note that two-thirds of sufferers will not have the classic ‘worse on waking’ pattern. Can mimic chronic migraine or chronic TTH. Bottom line: be very suspicious of any new headaches or significant changes in previous headache pattern.
  • Visual loss: as well as diplopia, it’s possible to get blurred vision and transient loss of vision/greying-out of vision (often associated with postural change and lasting less than a minute). Typically the fields, rather than the acuity, are affected; acuity is typically normal.
  • Pulsatile tinnitus: a rhythmic whooshing sound heard in one or both ears, synchronous with the heartbeat (probably 2ry to intensified vascular pulsation from the high RCP).
  • Vomiting
  • Neck or back pain
  • Lethargy/weakness
  • Behavioural changes
  • Problems with moving or talking
  • Decreased consciousness
  • Seizures


  • Check BP: malignant hypertension is a rare cause of RICP that is treatable.
  • Full neuro examination.
  • Optic discs: look not just for blurred disc margin, but also for obscuration of the vessels over the disc (you should be able to see them extending onto the disc, and if you can’t then that’s a danger sign) and disc hyperaemia (reddening of the central area).

Note that if papilloedema is seen, the person needs same day neuroimaging.

About Dr Sarah

I'm a GP with a husband and two young children.
This entry was posted in Credits 2019, Don't miss, Headache, Neurology. Bookmark the permalink.

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