30th December 2024

Presentation of malignant raised ICP

Symptoms of malignant raised ICP

Patients usually complain of a headache that is characteristically worse in the mornings (or after lying flat) and relieved on standing up. It may be worsened by valsalva manoeuvres such as coughing or sneezing.

It is also common for patients to describe progressive nausea and vomiting.

There may be cognitive change or impairment, drowsiness, and in severe cases, seizures and reduced GCS.

Examination in malignant raised ICP

Fundoscopy may show papilloedema.

Neurological examination may reveal disturbed gait, weakness or sensory loss depending on tumour location.

There may be other ‘false localising’ signs due to raised ICP, including cranial nerve palsies, most commonly CN VI palsy (paralysis of the medial rectus and failure of the eye to abduct). There may also be palsies of CN V (facial numbness) and CN VII (facial weakness).

If there is transtentorial herniation, there may be a surgical CN III palsy (ipsilateral mydriasis), which may be followed by complete CN III palsy (ptosis and down-and-out orientation of the eye) as the herniation progresses. Herniation will eventually result in midbrain compression – causing coma, altered respiratory and cardiovascular control, bradycardia and hypertension.