Brain shift, level of consciousness, and restoration of consciousness in patients with acute intracranial hematoma

Abstract

Recently, Ropper reported that horizontal brain shift caused by acute unilateral mass lesions correlated closely with consciousness, and suggested that recovery of consciousness was unlikely to occur after surgical evacuation if the shift was insufficient to explain the observed diminution of consciousness. The authors have sought to confirm the correlation of pineal shift with level of consciousness and to assess the prognostic value of brain shift measurements in a prospective study. Forty-six patients (19 with subdural hematoma, 14 with intracerebral hematoma, and 13 with epidural hematoma) were accrued to the study group consecutively. A correlation was found between a decrease in the level of consciousness and a significant increase in the mean lateral brain displacement at the pineal gland (from 3.8 to 7.0 mm) and septum (5.4 to 12.2 mm). When outcome was examined in patients who were stuporous or comatose on admission, a significant increase in septal shift was found among patients with a poor outcome, but there was no significant relationship between outcome and degree of pineal or aqueductal shift. A poor outcome was more likely with effacement of both perimesencephalic cisterns or the ipsilateral cistern, but not the contralateral cistern, although this difference did not reach statistical significance. These results do not substantiate the value of brain shift as an independent prognostic factor after evacuation of an acute unilateral mass lesion. The decision to operate and the determination of prognosis should be based rather on established criteria such as the clinical examination, age of the patient, and the mechanism of injury.

Evaluation of the Relationship of Intracranial Pressure with the Levels of Hypothalamic-Pituitary-Gonadal Axis Hormones on Prognosis in Severe Brain Injury

“…The relationship of poor prognosis with the presence of the midline shift and compression of the basal cistern especially in initial CCT have been reported by various researchers in the literature (1)(2)(3)(4)(5)(6)(7)(8)(9)(10). In our study, we found that compression of basal cisterns increased overall mortality, and this finding was found to be associated with poor prognosis.…”

Motor Vehicle Crash-Related Subdural Hematoma from Real-World Head Impact Data

“…The clinical importance of this association is supported by the observation that four out of five fatal crashes in this study experienced midline shift, the magnitude of which is known to be the most important parameter in predicting morbidity and mortality by CT imaging. [29][30] In this study, occupants with combined basilar and cranial vault fractures had statistically significantly greater midline shift than those who did not sustain a fracture. Although fractures were only observed in 17 of the occupants, these data support reported findings that skull fractures increase the risk of TBI.…”

Tracing the Deformed Midline on Brain Ct

“…MLS continued to be an important parameter on analysis of coronal MRI images, but Ropper failed to demonstrate the relationship between vertical brain shift and clinical condition on coronal MRI [5]. Also using axial CT images, other authors confirmed midline shift at septum pellucidum as a significant predictor of outcome, but not shift of pineal body or cerebral aqueduct [6]. These seemingly contradictory results highlighted the complexity of MLS measurement, which results from the interaction between different types of intracranial tissue.…”