Raised intracranial pressure. Diagnosis and management.

The complications resulting from increased intracranial pressure are serious and include visual impairment, compromise of venous and arterial circulation, and brain herniation. Thus, early diagnosis of increased pressure is essential. The presence of papilledema is important in making the diagnosis; however, important exceptions exist. Diagnostic lumbar puncture is not usually a recommended procedure. The choice of therapeutic agents depends mainly on the urgency of the clinical situation and the clinician's experience. The hypertonic osmotic diuretics rapidly reduce elevated intracranial pressure but, with the exception of glycerol, must be restricted to urgent situations because of complications associated with their use.