ABSTRACT
Symptoms of raised intracranial pressure include a ‘high-pressure headache’ that is worse on coughing or bending forward. High-pressure headaches may be accompanied by nausea and vomiting, blurred vision and double vision: cranial nerve compression can result in eye movement and pupil abnormalities. Fundoscopy can detect papilloedema, but this takes time to develop so may be absent in the acute phase. Outside the emergency setting many pathologies, as well as the anatomy relating to potential treatments such as third ventriculostomy, may be better visualised on magnetic resonance imaging. Normal pressure hydrocephalus is an important cause of dementia since it is readily reversible. It may be idiopathic or develop in the context of previous brain insults, including subarachnoid haemorrhage, head injury, meningitis and tumour. Ventriculoperitoneal shunting comprises the insertion of a proximal or ventricular catheter into the lateral ventricle, while a distal catheter is tunnelled subcutaneously to the abdomen.
