الفهرس 
IntroductionOnly 14 pages are availabe for public view
 |  | from | 123 |  |  |
| | | from | 123 | | |
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.
2. The second measurement (method 2), normally used by our neuroradiologists, measured the distance between the ideal mid line and the septum pellucidum.
The ultrasound MLS was measured through the temporal acoustic bone window. The third ventricle was identified as a double hyperechogenic 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 readings divided by two was used to calculate the MLS.
Measurement of MLS by transcranial sonography was possible in all 45 patients. MLS of 4.29 ± 2.17mm. A MLS >6 mm was observed in 24% (11/45) of the patients. CT MLS was 5.18 ± 2.49 mm (using method 1) and 5.35 ± 2.64 mm (using method 2). A MLS >8 mm with CT was observed in 29%(13/45) of the patients.
. The sensitivity and the specificity of US to detect a significant MLS (that is, MLS >5mm) was 100 ,91.3% respectively when using CT method (2) to measure MLS. The sensitivity and the specificity of US to detect a significant MLS (that is, MLS >5mm) was 95.2, 95.8% respectively when using CT method (1) to measure MLS.
The correlation coefficient between (the difference between US MLS and CTMLS) and CTMLS was 0.619 (p<0.001).The smaller the MLS the narrower the difference between the measurement of USMLS and CTMLS.
The narrowest difference between US MLS and CT MLS 0.5 (0.5 -0.7) was at MLS <2mm. At this reading was the most accurate point of comparison between US MLS and CTMLS.
The relation between US MLS and GCS was statistically significant, the greater the US MLS the lower the GCS. The relation between US MLS and length of ICU stay and ventilation days was tested and it was statistically significant. The greater the US MLS the longer the length of ICU stay and ventilation days.
There was significant relation between US MLS and mortality, 100 % of the cases survived with US MLS less than 4 mm. 100 % of the cases with US MLS greater than 6mm died. The greater the US MLS the higher the mortality.