6. Evaluation of Elevated Intracranial Pressure

Intracranial Hemorrhage

Intracranial hemorrhage occurs when a blood vessel within the skull ruptures or leaks. This condition can occur with physical trauma from a head injury or a ruptured aneurysm. The rapid build-up of blood can increase the ICP so quickly that permanent brain damage can occur if the pressure is not alleviated.

Oftentimes, these patients are comatose and will need emergent lowering of their ICP using pharmacologic (mannitol and hypertonic saline) or neurosurgical decompression.

Intracranial Hemorrhage Ultrasound Findings

On ocular ultrasound, you will find elevated ONSD measurements > 5 mm. Because ultrasound scanning for this condition is often done soon after trauma, there may not be enough time for the elevated ICP to progress to papilledema. Therefore, it is unlikely to see optic disc bulging from an acute intracranial hemorrhage on ultrasound. This contrasts with chronically increased intracranial pressure where the optic nerve swelling can be visualized with ultrasound.

ONSD Dilation Illustration
Intracranial Hemorrhage with dilated ONSD Ocular Ultrasound
Increased ICP and Dilated ONSD

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