Which change in vital signs would indicate increased intracranial pressure in a patient with a subdural hematoma?

• A. Tachypnea
• B. Bradycardia
• C. Hypotension
• D. Narrowing pulse pressure

Answer: (B)

When intracranial pressure rises, the body often mounts a Cushing reflex to preserve cerebral perfusion: systolic blood pressure increases while the heart rate slows and respirations become irregular. This bradycardia is a hallmark sign of increased ICP, especially in the context of a subdural hematoma where the pressure behind the skull is climbing and push on the brainstem triggers autonomic responses.

Bradycardia fits best because it directly reflects the reflex slowing of the heart in response to rising blood pressure. The other options don’t align with this ICP pattern: tachypnea isn’t the classic respiratory response to elevated ICP (irregular breathing is more typical); hypotension would indicate poor cerebral perfusion and isn’t part of the Cushing response; narrowing pulse pressure (a small gap between systolic and diastolic pressure) contrasts with the widened pulse pressure often seen when ICP is up, where systolic pressure rises more than diastolic.

So, bradycardia signals the brain’s compensatory attempt to maintain perfusion in the setting of rising intracranial pressure.