Assessment of Brain Midline Shift Using Sonography in Traumatic Brain Injury (TBI) in Critically Ill Patients: A Comparative Study with CT

Abstract

Brain midline shift (MLS) is a life-threatening condition that requires urgent diagnosis and treatment. In addition to the clinical examination, computed tomography (CT) scan has become the corner stone for the care of neurocritical patients. The early detection of a MLS in neurosurgical ICU patients is thus very important because it allows the implementation of an appropriate treatment plan. Head CT is considered to be the gold standard to diagnose MLS, serial CTs in neurosurgical ICU patients can be associated with significant morbidity and secondary brain injuries post-transfer related to their transport. This study aimed to assess the brain midline shift using transcranial sonography and compare it with that of plain CT in neurocritical patients. The study was carried out on 45 adult patients of both sex admitted to Ain shams University Hospitals at the critical care units who were indicated for plain brain CT scan. The measurement of the MLS with CT scan was done by two methods for each patient: 1. The first measurement (method 1): the distance between the external bone table and the center of the third ventricle was measured from the CT slice among the 5-mm-wide cuts in the orbito-meatal plane that allowed visualising the third ventricle.