Question

The following are the clinical features of raised intracranial tension EXCEPT

• A. Headache
• B. Insomnia
• C. Bradycardia
• D. Papilloedema

Hint:

Recall that raised intracranial tension causes drowsiness, not difficulty sleeping.

Answer 1

The Correct Option is B

Step 1: Understanding the Question:
We need to spot the one option that is NOT a recognised sign of raised pressure inside the skull (raised intracranial tension).

Step 2: Key Formula or Approach:
The classic triad of raised intracranial tension is headache, vomiting, and papilloedema. When the pressure rises very high, it also triggers the Cushing reflex, made up of a slow heart rate (bradycardia), high blood pressure, and irregular breathing. Level of consciousness drops as pressure rises, so patients become drowsy rather than unable to sleep.

Step 3: Detailed Explanation:
Headache is a core feature. It is classically worse in the early morning and worsens further with coughing, straining, or bending forward, all of which raise pressure further.
Papilloedema, swelling of the optic disc from blocked flow along the optic nerve sheath, is a direct sign found on eye examination and is part of the classic triad.
Bradycardia is part of the Cushing reflex. As pressure inside the skull rises and starts to squeeze the brainstem, the body reacts with a slow pulse together with a rise in blood pressure, a well known and important late sign.
Insomnia, or difficulty sleeping, is not a recognised feature. In fact, raised intracranial tension usually causes drowsiness and a falling level of consciousness as it worsens, the opposite of being unable to sleep.

Step 4: Final Answer:
Since headache, bradycardia, and papilloedema are all accepted features of raised intracranial tension, and insomnia is not, insomnia is the correct exception.