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Combination of Tests

History

Physical Exam

Increased Intracranial Pressure: Sensitivity and Specificity

Introduction: It is contraindicated to perform a lumbar puncture on a patient with increased intracranial pressure because of the danger of herniation. The gold standard test for elevated ICP is CT scan.

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The sensitivity and specificity of findings for Increased Intracranial Pressure are listed below. See the left navigation bar to change the display.

Combination of Tests

Finding SensitivitySpecificity Comments, Study
Clinical diagnosis Edit 100%94.7%

i.e. based on abnormal findings on history or physical exam

gold standard is CT (? is LP contraindicated)

Study: Arch Intern Med. 1999 Dec 13-27;159(22):2681-5. PMID: 10597758

History

Finding SensitivitySpecificity Comments, Study
History of CNS Mass Edit 11.9%96.8%

gold standard is CT (? is LP contraindicated)

Study: Arch Intern Med. 1999 Dec 13-27;159(22):2681-5. PMID: 10597758

History of Head Trauma Edit 6%91%

Within last 72 hours

(Note: NOT DIAGNOSTIC!)

gold standard is CT (? is LP contraindicated)

Study: Arch Intern Med. 1999 Dec 13-27;159(22):2681-5. PMID: 10597758

History of HIV Edit 20%83.3%

HIV positivity

gold standard is CT (? is LP contraindicated)

Study: Arch Intern Med. 1999 Dec 13-27;159(22):2681-5. PMID: 10597758

History of Seizure Edit 18%87%

Within last 72 hours

gold standard is CT (? is LP contraindicated)

Study: Arch Intern Med. 1999 Dec 13-27;159(22):2681-5. PMID: 10597758

Immunosuppressed Edit 47.9%69.5%

gold standard is CT (? is LP contraindicated)

Study: Arch Intern Med. 1999 Dec 13-27;159(22):2681-5. PMID: 10597758

Physical Exam

Finding SensitivitySpecificity Comments, Study
Altered Mental Status Edit 76.5%65.2%

gold standard is CT (? is LP contraindicated)

Study: Arch Intern Med. 1999 Dec 13-27;159(22):2681-5. PMID: 10597758

Focal Neurological Signs Edit 42.3%90.2%

gold standard is CT (? is LP contraindicated)

Study: Arch Intern Med. 1999 Dec 13-27;159(22):2681-5. PMID: 10597758

Papilledema
Duplicate Edit
12%98.9%

by emergency medicine residents in the ED

gold standard is CT (? is LP contraindicated)

Study: Arch Intern Med. 1999 Dec 13-27;159(22):2681-5. PMID: 10597758

Papilledema
Duplicate Edit
80.4%82.9%

by ophthalmologists viewing a picture of a stereoscopic view of a dilated eye

Study: J Fam Pract. 1991 Oct;33(4):381-6. PMID: 1919455

Papilledema
Duplicate Edit
59.3%84.5%

by family practitioners viewing a picture of a stereoscopic view of a dilated eye

Study: J Fam Pract. 1991 Oct;33(4):381-6. PMID: 1919455