Midline shift

Midline shift (arrow) is present in this brain after a stroke (infarct depicted in shaded area).

This subdural hematoma/epidural hematoma (arrows) is causing midline shift of the brain

Midline shift is a shift of the brain past its center line.^[1] The sign may be evident on neuroimaging such as CT scanning.^[1] The sign is considered ominous because it is commonly associated with a distortion of the brain stem that can cause serious dysfunction evidenced by abnormal posturing and failure of the pupils to constrict in response to light.^[1] Midline shift is often associated with high intracranial pressure (ICP), which can be deadly.^[1] In fact, midline shift is a measure of ICP; presence of the former is an indication of the latter.^[2] Presence of midline shift is an indication for neurosurgeons to take measures to monitor and control ICP.^[1] Immediate surgery may be indicated when there is a midline shift of over 5 mm.^[3] The sign can be caused by conditions including traumatic brain injury^[1] and stroke that raise intracranial pressure.

See also

• Mass effect (medicine)

References

1. ^ ^{a b c d e f} Gruen P (May 2002). "Surgical management of head trauma". Neuroimaging clinics of North America 12 (2): 339–43. doi:10.1016/S1052-5149(02)00013-8. PMID 12391640. 
2. ^ Maas AI, Stocchetti N, Bullock R (August 2008). "Moderate and severe traumatic brain injury in adults". Lancet Neurology 7 (8): 728–41. doi:10.1016/S1474-4422(08)70164-9. PMID 18635021. 
3. ^ Valadka AB (2004). "Injury to the cranium". In Moore EJ, Feliciano DV, Mattox KL. Trauma. New York: McGraw-Hill, Medical Pub. Division. pp. 389. ISBN 0-07-137069-2. http://books.google.com/?id=VgizxQg-8QQC&pg=PA545&dq=tracheobronchial. Retrieved 2008-08-15.