Which of the following is NOT an early sign of increased intracranial pressure?

• A. Decreased LOC.
• B. Headache.
• C. Bradycardia.
• D. Projectile vomiting.

Answer: (C)

When intracranial pressure begins to rise, the brain’s response tends to show early dysfunction in the higher centers rather than brainstem failure. Early signs reflect cerebral irritation and impaired consciousness, so alterations in level of arousal, along with headache from meningeal stretching and vomiting from stimulation of the brain’s vomiting center, are common initial indicators. Bradycardia, on the other hand, is part of the late Cushing reflex, a brainstem–related response that appears as ICP becomes severe and the body attempts to maintain perfusion despite rising pressure. It signals decompensation and potential herniation, not an early warning. So bradycardia is not an early sign; the other symptoms align with the initial ICP changes.