UMEM Educational Pearls

Category: Neurology

Title: Management of Increased Intracranial Pressure

Keywords: increased intracranial pressure, opening pressure (PubMed Search)

Posted: 12/21/2011 by Aisha Liferidge, MD (Updated: 7/22/2024)
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  • When performing a lumbar puncture, an opening intracranial pressure (ICP) greater than 20 to 25 mm of H2O is elevated.  


  • If it is thought that a patient's headache is due to elevated pressure, cerebrospinal fluid (CSF) can be therapeutically removed.  It is typically recommended that the pressure not be lowered by more than 50% of the amount above which it is normal.


  • The source of elevated ICP should be determined and addressed.  Common causes of increased intracranial pressure include:

             --- Venous drainage obstruction (i.e. cerebral venous sinus thrombosis).

             --- Endocrine (i.e. obesity, hypothyroidism, Cushing's disease, Addison's disease).

             --- Medications (i.e. vitamin A, cyclosporine, lithium, lupron, oral contraceptives,

                  amiodorone, and antiobiotics such as tetracyclines and sulfonamides).

             --- Other conditions (i.e. pregnancy, steroid withdrawal, acromegaly, polycystic ovary

                  syndrome, systemic lupus erythematosus, sleep apnea, HIV).