Which of the following is a red flag for intracranial hypertension?

• A. Decreasing GCS
• B. Fever
• C. Seizures only
• D. Headache

Answer: (A)

A rise in intracranial pressure most reliably shows up as a deterioration in brain function, which the Glasgow Coma Scale (GCS) tracks. A decreasing GCS means the patient is less responsive or conscious, reflecting that the brain isn’t functioning normally due to rising pressure. This change signals potential brain edema, bleeding, or mass effect and alerts you to urgent evaluation and management to prevent herniation.

Fever can point to infection or systemic illness and isn’t a direct indicator of intracranial pressure. Seizures can occur with brain injury but don’t specifically reflect a change in ICP. Headache is common and nonspecific. Among these, a falling GCS best signals intracranial hypertension and warrants immediate assessment.