An indicator of an expanding intracranial hematoma or rapidly progressing brain swelling is:

• A. Progressively lowering blood pressure.
• B. Rapid deterioration of neurologic signs.
• C. Acute unilateral paralysis following the injury.
• D. Acute increase in the patient\'s pulse rate.

Answer: (B)

Rapid deterioration of neurologic signs is the best indicator because it reflects the brain’s response to growing pressure from a hematoma or swelling. As the bleed or swelling expands, intracranial pressure rises, reducing cerebral perfusion and quickly compromising brain function. This sudden drop in neurologic status—such as increasing drowsiness, confusion, new or worsening weakness, or changes in consciousness—signals that the hematoma is enlarging and urgent intervention is needed.

Other signs listed are less specific. Lower blood pressure can result from shock or systemic illness and does not directly indicate hematoma growth. A new focal deficit like unilateral paralysis might occur from the original injury but isn’t a reliable cue that the bleed is expanding. A rapid pulse is not a hallmark of increasing intracranial pressure; in advanced ICP, the body may show bradycardia with hypertension rather than tachycardia.