Which feature indicates a late sign of increased intracranial pressure?

Dilated, nonreactive pupils are a critical feature indicating a late sign of increased intracranial pressure (ICP). This condition arises when there is a significant increase in pressure within the cranial cavity, which can be caused by various factors such as tumors, bleeding, or edema. As ICP rises, it can lead to dysfunction of the brain stem, where the pupillary response is regulated. When pupils become dilated and nonreactive, it suggests that there is a significant compromise in brain function and a potential risk of herniation, which is a life-threatening emergency.

The other features listed may also indicate issues with ICP but are typically observed earlier in the progression of increased pressure. For example, widened pulse pressure can be a sign of increased ICP but is more often associated with conditions like Cushing's triad or significant cardiovascular changes rather than serving as a specific late sign. An altered level of consciousness can occur during various stages of increased ICP, serving as an earlier indicator rather than a late sign. Headaches, while common in those experiencing elevated ICP, can also occur in various other conditions and do not specifically indicate a late stage of increased ICP. Thus, the presence of dilated, nonreactive pupils is a clear and alarming indicator