Raised intracranial pressure with upright posture.

We describe the phenomenon of paradoxical intracranial hypertension with upright posture with normal recumbent intracranial pressure (ICP). This effect was measured by direct ICP monitoring in a patient who had a lumboperitoneal shunt for idiopathic intracranial hypertension. Bilateral subtemporal surgical decompression to increase intracranial compliance with confirmatory perioperative pressure monitoring was central to the successful management of this patient.