Urgent CT Brain if appropriate.

• Raise the head of the patient’s bed
• If intracranial bleed suspected stop anticoagulants
• Symptom relief with analgesia and anti-emetics ( cyclizine 25-50mg po / IV tds or ondansetron 4mg twice a day can be effective in patients with raised ICP
• Consider referral to neurosurgery if appropriate

For patients with cancer:

• Raised ICP may be caused by the cancer mass, oedema surrounding it or a bleed into or around the tumour
• Involve the patient’s cancer site-specific Clinical Nurse Specialist (CNS) to understand the implications for the patient’s prognosis, and whether disease-modifying therapy would be offered. Our local CNSs work closely with the oncology teams in Edinburgh. A palliative care team referral is often also appropriate.
• Consider a trial of corticosteroids with gastroprotection (usually a proton pump inhibitor):
  • Dexamethasone 8mg to 16mg orally (or IV) immediately.
  • Followed by Dexamethasone 4mg to 8mg twice daily orally, given at breakfast and lunchtime to avoid insomnia.