Refractory intracranial hypertension due to fentanyl administration following closed head injury

Sara E. Hocker, Jeremy Fogelson, Alejandro A. Rabinstein

Research output: Contribution to journalArticlepeer-review

9 Scopus citations


Background: Although the effects of opioids on intracranial pressure (ICP) have long been a subject of controversy, they are frequently administered to patients with severe head trauma. We present a patient with an uncommon paradoxical response to opioids. Case Report: A patient with refractory intracranial hypertension after closed head injury was managed with standard medical therapy with only transient decreases in the ICP. Only after discontinuation of opiates did the ICP become manageable without metabolic suppression and rescue osmotic therapy, implicating opiates as the etiology of refractory intracranial hypertension in this patient. Conclusion: Clinicians should consider opioids as a contributing factor in malignant intracra- nial hypertension when findings on neuroimaging do not explain persistent and refractory intracranial hypertension.

Original languageEnglish (US)
Article numberArticle 3
JournalFrontiers in Neurology
Volume4 JAN
StatePublished - 2013


  • Closed head injury
  • Fentanyl
  • Intracranial hypertension
  • Morphine
  • Opioids
  • Traumatic brain injury

ASJC Scopus subject areas

  • Neurology
  • Clinical Neurology


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