What is an early sign of increased intracranial pressure?

• A. Increased blood pressure
• B. Change in mental status
• C. Decreased temperature
• D. Pupillary dilation

Answer: (B)

Changes in mental status signal brain dysfunction from rising pressure. As intracranial pressure increases, cerebral perfusion becomes impaired, and the brain's ability to function normally is affected first, leading to confusion, irritability, restlessness, or lethargy in children. This altered level of consciousness is typically the earliest sign clinicians notice before other neurological changes develop. In comparison, a rise in blood pressure is more of a late adaptive response (the Cushing reflex) seen with more advanced ICP, often accompanied by other signs. Temperature change is not a common early indicator of ICP elevation. Pupillary dilation tends to occur later as pressure progresses and can indicate impending herniation rather than an early sign. Recognizing an early change in mental status allows for prompt assessment and intervention to prevent further deterioration.