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30th December 2024
Management of malignant raised ICP
The aims of initial management are to reduce oedema with high-dose corticosteroids, relieve symptoms and prevent or treat seizures. Urgent neurosurgical or oncological or neurosurgical advice is required to advise on definitive management.
| 1. High-dose corticosteroids – dexamethasone 16 mg stat then OD + PPI |
| 2. If not responding to steroids, IV mannitol may be considered for osmotic diuresis. |
| 3. Manage seizures; consider ongoing or prophylactic AEDs, for example with levetiracetam |
| 4. Symptom relief with analgesia and antiemetics; dexamethasone may ease symptoms but may take time to work and is not a long term measure. Additional antiemetics of choice would be those that act centrally – including cyclizine, levomepromazine and haloperidol. |
| 5. Urgent discussion with oncology and neurosurgical teams to consider definitive management; may require shunt for hydrocephalus, chemotherapy (if chemosensitive), radiotherapy (whole brain or stereotactic) |
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