Signs of Raised Intracranial Pressure (ICP)

From APLS manual 6E

  1. Abnormal oculocephalic reflexes (avoid in patients with neck injuries):
    When the head is turned to the left or right a normal response is for the eyes to move away from the head movement; an abnormal response is no (or random) movement. See video for a demo of normal reflexes.
  2. Abnormal Posture:
    Decorticate (flexed arms, extended legs)
    Decerebrate (extended arms, extended legs)
    Posturing may need to be elicited by a painful stimulus
  3. Abnormal pupillary responses: unilateral or bilateral dilatation suggests raised ICP
  4. Abnormal breathing patterns: There are several recognisable breathing pattern abnormalities in raised ICP. However they are often changeable and may vary from hyperventilation to Cheyne-Stokes breathing to apnoea
  5. Cushing’s Triad: Hypertension, Bradycardia and breathing pattern abnormalities are a late sign of raised ICP

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