Radiological features of Raised ICP on CT Brain (in a nutshell)

Radiological features of Raised ICP on CT Brain (in a nutshell)

🧠 Key CT Findings





1. Sulcal effacement

  • Loss/obliteration of cortical sulci
  • Earliest sign of diffuse cerebral edema

2. Ventricular compression

  • Slit-like or reduced size of lateral and third ventricles
  • May progress to near-complete effacement

3. Basal cistern effacement

  • Obliteration of:
    • Suprasellar cistern
    • Perimesencephalic cistern
    • Ambient cistern
  • Strong indicator of significant ICP rise

4. Midline shift

  • Displacement of septum pellucidum
  • Indicates mass effect (quantify in mm)

5. Diffuse cerebral edema

  • Loss of gray–white matter differentiation
  • Generalized hypodensity of brain parenchyma

6. Herniation signs

  • Subfalcine → cingulate gyrus shift under falx
  • Uncal (transtentorial) → medial temporal lobe displacement
  • Tonsillar → cerebellar tonsils descending (better on MRI but indirect CT signs present)

7. Effacement of CSF spaces

  • Narrowing/obliteration of:
    • Cortical sulci
    • Ventricles
    • Cisterns

🔑 Compact Mnemonic

“SVeB MeD Her”

  • Sulci effaced
  • Ventricles compressed
  • Basal cisterns obliterated
  • Midline shift
  • Diffuse edema (↓ G-W differentiation)
  • Herniation signs

⚠️ Practical note (high-yield)

  • Basal cistern effacement + GCS drop = impending herniation
  • Always correlate with cause: mass lesion, hemorrhage, edema, hydrocephalus

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