Management of raised intracranial pressure in palliative care

Raised intracranial pressure causes a cluster of presenting or evolving symptoms including headache, nausea and vomiting, impaired consciousness, seizures and blurred vision.

Causes of raised intracranial pressure in patients with palliative care needs include intracerebral masses, haemorrhage, raised venous pressure and obstruction of cerebrospinal fluid flow.

Management of raised intracranial pressure depends on the cause, potential benefits and burdens of investigations and treatment, and the patient’s prognosis, preferences and goals of care—see Principles of symptom management in palliative care.

Measures to improve symptoms (eg elevating the bedhead, treating pain, nausea or vomiting or seizures) are key aspects of management. Corticosteroid therapy may reduce headache and improve consciousness in patients with brain cancer. Consider whether active treatment options are appropriate, for example, intubation, hyperosmolar therapy and hyperventilation and, for patients with brain cancer, radiotherapy, surgery, stereotactic radiosurgery and chemotherapy. Active treatments may provide symptomatic relief but may not be the most effective method to achieve this goal, and may be burdensome.