الفهرس 
Monitoring the effect of hyperosmolar solutions on brain midline shift using transcranial ultrasonography in severe traumatic brain injury
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Abstract
Introduction. Severe traumatic brain injury (TBI) associated with Brain midline shift (MLS) is a life-threatening condition that requires urgent diagnosis and treatment (Quattrocchi et al., 1992). Brain sonography is an important recent technological advances, which is able to visualize most of the intracerebral structures. This is a non-invasive technology, associated with low radiation exposure, it can be done at bedside and has been used as an additional tool for the evaluation of traumatic brain injury. Methods. 55 patients were admitted to the Critical Care Medicine Department with severe traumatic brain injury with a Glasgow Coma Scale (GCS) score of 3-8 on admission.The ultrasound MLS was measured through the temporal acoustic bone window after the brain CT. The third ventricle was identified as a double hyper-echogenic image over the midbrain; the distance between the external bone table and the centre of the third ventricle was measured bilaterally, the difference between two measures divided by two is used to calculate MLS.MLS was measured using transcranial sonography at day of admission and repeated after 48 hours after using hyperosmolar solutions.The results were compared by the results of CT brain at day of admission and after 48 hours Results. Comparing the negative difference in the MLS in U/S and CT I, if the difference was >1 mm in U/S and in CT occurred in 18 out of our cases (32.73%) while when the negative difference was >1mm in U/S and it was {u2264}1 mm occurred in 6 cases (10.91%) while when the negative difference in U/S was {u2264}1 mm and it was >1 mm occurred in 21 cases (38.18%) and when the negative difference was {u2264}1mm and in CT I also {u2264}1 mm occurred in 28 cases (50.91%)