Name three CT findings that raise concern for raised ICP in acute TBI.

• A. Midline shift, compressed or ruptured basal cisterns, large mass effect from hematoma or edema.
• B. Normal CT without any mass effect.
• C. Isolated skull fracture without brain injury.
• D. Only ventriculomegaly.

Answer: (A)

Raised ICP in acute TBI is suggested on CT by signs of mass effect and brainstem compression. Midline shift shows the brain tissue being pushed off the midline by a mass lesion or swelling, indicating substantial intracranial pressure. Compressed or ruptured basal cisterns mean the CSF spaces around the brainstem are flattened or obliterated, reflecting rising pressure and distortion of the brainstem with a high risk of herniation. A large mass effect from a hematoma or edema means a lesion or diffuse swelling is large enough to displace or compress surrounding brain structures, often with ventricular compression or sulcal effacement, correlating with dangerous ICP levels. These are the red flags that necessitate urgent management. By contrast, a CT that is normal without mass effect or an isolated skull fracture without brain injury does not indicate raised ICP, and ventriculomegaly alone is not a definitive sign of acute ICP elevation.