Chapter 55 Raised intracranial pressure
General features of raised intracranial pressure
Headache (see Chapter 108)
1. Headaches that wake the patient at night or are worse on awakening.
2. Headache associated with visual obscuration associated with changes in posture.
3. Supratentorial tumors typically produce frontal headaches.
4. Posterior fossa tumors usually produce occipital headache or neck pain.
5. Nausea and vomiting may be features of RICP (or fourth ventricle tumors).
Hydrocephalus and shunts
1. Obstructive: there is a block preventing CSF circulation within the ventricular system.
2. Communicating: when reabsorption in the subarachnoid space is impaired.
Ventriculo-peritoneal shunt insertion is the most commonly performed pediatric neurosurgical procedure. In a series from the United States, 69 000 discharges and 36 000 procedures related to shunts were performed in 1995. The population with hydrocephalus has grown considerably since that study due to improved survival of very premature infants. The morbidity due to complications remains significant. In one UK series, there was a 11% mortality rate during a 10-year follow-up study of 155 children.1