Which sign would appear first with increased ICP after head trauma?

• A. Bradycardia
• B. Large amounts of very dilute urine
• C. Restlessness and confusion
• D. Widened pulse pressure

Answer: (C)

When intracranial pressure starts to rise after head injury, brain function is affected first, so the earliest clue in a child is a change in mental status. Restlessness and confusion reflect this early disruption of consciousness and perception as perfusion to the brain becomes inadequate.

As ICP continues to escalate, more overt signs appear, such as the body’s compensatory responses like a slowed heart rate and changes in blood pressure, which indicate more severe brain compression. Urine changes like very dilute urine point to pituitary injury (diabetes insipidus) rather than being an early indicator of rising ICP.