Which of the following is a manifestation of increased intracranial pressure?

• A. Right pupil dilated greater than left pupil.
• B. Fever
• C. Oriented to name only
• D. Narrowing pulse pressure

Answer: (A)

Rising intracranial pressure often pushes brain tissue toward the tentorium, which can compress the oculomotor nerve. Compression of CN III on one side causes the pupil on that side to become dilated and less reactive to light, a unilateral blown pupil that can be an early sign of impending herniation. This makes a dilated, nonreactive pupil the most specific and urgent manifestation of increased ICP among the options.

Fever isn’t a direct sign of ICP; it points toward infection or inflammation. Being oriented to name only reflects altered consciousness in a broad sense and isn’t specific to ICP. Narrowing pulse pressure isn’t typical of ICP; when ICP rises, the body often shows Cushing’s triad—hypertension with widened pulse pressure, bradycardia, and irregular respirations—so a narrowing pulse pressure would be inconsistent with that response.