Suspected raised intracranial pressure

A normal CT or MRI means that intracranial pressure will be normal in the great majority of cases, although not all. The interpretation of 'generalized brain edema' is usually incorrect when the brain substance appears normal, and diffuse hyperemic brain swelling is more common. A mass inducing a midline shift, particularly when associated with dilatation of the contralateral ventricle, is an indication of raised intracranial pressure, as is progressive obliteration of the basal cisterns and compression of the brainstem (Fig 3). Imaging has shown that pressure cones (herniations) at either the tentorial hiatus or the foramen magnum usually are not lethal in themselves, and may even be asymptomatic (Fisher,,1995).

H4>Lumbar puncture and prior brain imaging

CT or MRI generally are not recommended prior to lumbar puncture unless consciousness is depressed or there are neurological signs. In most other cases the main reason for considering cranial imaging is that it may demonstrate lumbar puncture to be unnecessary or inappropriate.

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