Raised intracranial pressure in cancer

The Scottish Palliative Care Guidelines list the symptoms as a headache gradually increasing in severity, classically worse in the morning and on coughing, sneezing or bending, vomiting (commonly without nausea), visual disturbance, dizziness, personality change and seizures; signs such as raised blood pressure, altered consciousness, ocular palsies and papilloedema are often late, and diagnosis usually rests on the history. In people with cancer it may be caused by the tumour or by a bleed into or around it. Management in that guideline includes an urgent CT brain where appropriate, a trial of dexamethasone with gastroprotection (stopped promptly if there is no benefit and reduced gradually in responders), raising the head of the bed, stopping anticoagulants if a bleed is suspected, analgesia and antiemetics, and referral to oncology and neurosurgery.