Michael Eller; Peter J Goadsby


Expert Rev Neurother. 2013;13(3):263-273. 

In This Article

Symptoms of Altered ICP

Symptoms of raised ICP can include headache, nausea, lethargy, pulsatile tinnitus, diplopia and transient visual obscurations.[72] Focal symptoms and signs may occur concurrently, suggesting a space-occupying lesion such as tumor or abscess. Raised ICP can also have a number of other causes, such as impaired cerebrospinal fluid drainage and infection. It can also occur secondary to medication, such as minocycline or venous thrombosis. Raised ICP may be due to idiopathic intracranial hypertension, discussed above. This important condition tends to occur in overweight young women and can lead to significant alterations in patients' visual acuity, visual fields and eye motility, changes that can be permanent.[73]

Low ICP is typically but not universally manifested by orthostatic headache – this is characteristically absent on awakening. Accompanying symptoms can include nausea, photophobia, dizziness, hyperacusis and diplopia.[5,66] Cough and straining may exacerbate symptoms. The syndrome usually occurs due to a spontaneous or traumatic dural tear, such as after a lumbar puncture. Spontaneous leaks are associated with connective disuse disorders in up to two-thirds of the patients, according to one series.[66] MRI can demonstrate diffuse pachymeningeal enhancement and brain sag (Figure 2).[74]

Figure 2.

A patient with symptoms of low intracranial pressure including postural headache and hyperacusis. (A) A coronal and (B) axial T1 MRI with gadolinium demonstrating diffuse pachymeningeal enhancement.