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

This question wants the one option that does not belong on the list of signs of raised intracranial tension. Let's check each one.

1. Headache: A classic feature, typically worse on waking and made worse by coughing or straining.
2. Insomnia: Raised pressure inside the skull usually causes drowsiness and a falling level of alertness as it gets worse, not trouble falling asleep. This does not fit the usual picture.
3. Bradycardia: Part of the Cushing reflex, a slow pulse together with high blood pressure, appearing as the brainstem gets compressed by the rising pressure.
4. Papilloedema: Swelling of the optic disc from blocked flow along the optic nerve, a direct sign found on eye examination and part of the classic triad with headache and vomiting.

Three of the four, headache, bradycardia, and papilloedema, are textbook features. Insomnia does not fit since raised pressure causes sleepiness, not wakefulness.

Let's summarize:

• Headache, papilloedema, and bradycardia are established features of raised intracranial tension.
• Insomnia is not, since drowsiness rather than sleeplessness is what actually occurs.

So the exception among the clinical features of raised intracranial tension is insomnia.