<prompt> The earliest manifestation of increase intracranial pressure following head injury isHemiparesisAltered mental statusIpsilateral pupillary dilatationContralateral pupillary dilatation  <response>: Early signs of elevated ICP includes drowsiness and a diminished level of consciousness Coma and unilateral papillary changes are late signs and require immediate intervention Ref : Harrisons 19th edition Pgno :1779 