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Critical intracranial hypertension with Glasgow Coma Scale of 15
  1. Andrew James Baldock,
  2. Tom Bennett
  1. Southampton Children's Hospital, Southampton, UK
  1. Correspondence to Dr Andrew James Baldock, Paediatric Intensive Care Unit, University Hospital Southampton, Tremona Road, Southampton SO16 6YD, UK; Andrew.Baldock{at}

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We are concerned there may be a widely held misconception that critically rising intracranial pressure (ICP) is always accompanied by a progressive deterioration in Glasgow Coma Scale (GCS).1 We present two cases when the GCS remained 15, despite critically high ICP.

Case 1

A 15-year-old girl presented with a 2 month history of headaches and episodic vomiting. Her initial heart rate in the ward was 46 bpm and her blood pressure was 106/71. Her GCS was 15. Examination was unremarkable. Her heart rate fluctuated between 50 and 65. Approximately 7 h after admission, her headache became unbearable and she developed severe neck pain. Her blood pressure …

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  • Competing interests None.

  • Patient consent Obtained.

  • Provenance and peer review Not commissioned; internally peer reviewed.