In assessing a patient with a head injury, what is the earliest indication of increased ICP?

• A. Change in level of consciousness (LOC).
• B. Vomiting.
• C. Sluggish pupil response to light.
• D. Headache.

Answer: (D)

Rising intracranial pressure most quickly disrupts the brain's cortex and reticular activating system, so the first sign is a change in level of consciousness. A patient may become confused, irritable, drowsy, or less responsive as CPP falls and cerebral function is compromised. Headache, while common with increased ICP, tends to appear as ICP continues to rise and isn’t the earliest clue. Vomiting can occur but is not the initial indicator, and sluggish pupil response points to brainstem involvement that usually happens later. In head injury, noticing even subtle changes in orientation or alertness is a critical early warning that ICP may be increasing.