- Home
- Medical news & Guidelines
- Anesthesiology
- Cardiology and CTVS
- Critical Care
- Dentistry
- Dermatology
- Diabetes and Endocrinology
- ENT
- Gastroenterology
- Medicine
- Nephrology
- Neurology
- Obstretics-Gynaecology
- Oncology
- Ophthalmology
- Orthopaedics
- Pediatrics-Neonatology
- Psychiatry
- Pulmonology
- Radiology
- Surgery
- Urology
- Laboratory Medicine
- Diet
- Nursing
- Paramedical
- Physiotherapy
- Health news
- Fact Check
- Bone Health Fact Check
- Brain Health Fact Check
- Cancer Related Fact Check
- Child Care Fact Check
- Dental and oral health fact check
- Diabetes and metabolic health fact check
- Diet and Nutrition Fact Check
- Eye and ENT Care Fact Check
- Fitness fact check
- Gut health fact check
- Heart health fact check
- Kidney health fact check
- Medical education fact check
- Men's health fact check
- Respiratory fact check
- Skin and hair care fact check
- Vaccine and Immunization fact check
- Women's health fact check
- AYUSH
- State News
- Andaman and Nicobar Islands
- Andhra Pradesh
- Arunachal Pradesh
- Assam
- Bihar
- Chandigarh
- Chattisgarh
- Dadra and Nagar Haveli
- Daman and Diu
- Delhi
- Goa
- Gujarat
- Haryana
- Himachal Pradesh
- Jammu & Kashmir
- Jharkhand
- Karnataka
- Kerala
- Ladakh
- Lakshadweep
- Madhya Pradesh
- Maharashtra
- Manipur
- Meghalaya
- Mizoram
- Nagaland
- Odisha
- Puducherry
- Punjab
- Rajasthan
- Sikkim
- Tamil Nadu
- Telangana
- Tripura
- Uttar Pradesh
- Uttrakhand
- West Bengal
- Medical Education
- Industry
Transcranial Ultraound Useful Bedside Adjunct to Monitor Midline Shift in Patients with Decompressive Hemicraniectomy
A recent report by researchers in Kochi, India has shown that transcranial ultrasound (TCS) can measure midline shift (MLS) with high accuracy and can serve as a valuable bedside tool to monitor intracerebral lesions, especially in a neurocritical care setting.
Brain midline shift (MLS) secondary to raised intracranial pressure or space-occupying lesions is a common neurological emergency. It is imperative to make an early diagnosis and reassess at periodic intervals in the neuro-ICU (intensive care unit) to decide on treatment options. It usually occurs in the setting of raised Intracranial Pressure (ICP) owing to various causes such as intracranial hemorrhage, traumatic brain injury, neoplasms and secondaries, hydrocephalus, cerebral edema, etc. Some of the above conditions result in a prolonged hospital stay. These patients require serial follow-up with multimodal investigations such as computed tomography (CT) or magnetic resonance imaging (MRI). Shifting a comatose patient repeatedly for neuroimaging and the cumulative radiation exposure becomes troublesome and time consuming. Bedside MRI is only available in the US in select centers. Usage of transcranial ultrasonography (TCS) helps in serially monitoring a patient at the bedside. Bedside monitoring, avoidance of radiation exposure, and cost effectiveness are additional advantages. With TCS, follow-up of the patient is convenient as it can also be done in an outpatient clinic. Ultrasound waves are used to image the intracranial structures and perform measurements. Due to the nature of ultrasound waves, it cannot be performed in patients with thick skulls, elderly individuals, or where a bone window does not exist.
Decompressive craniectomy is performed to reduce the ICP. Even after decompressive craniectomy, MLS may progress or change and require additional therapeutic interventions. Theoretically, such patients make ideal candidates for TCS as a large iatrogenic bone-free window is available for repeated measurements. Visualization of brain anatomy is much easier and more convenient in these patients.
In the study, which was published in neurology india, the authors included patients who had undergone decompressive craniectomy due to various reasons like ICH, traumatic brain injury, etc., and have a MLS. Trans cranial ultrasonography was assessed by a single consultant (Neuro Critical Care Intensivist) who was blinded for the CT scan measurement. CT scan measurement of MLS was assessed by a neuroradiologist using standard guidelines, who was blinded for the TCS results of MLS. The finding of a MLS >0.5 cm in the CT scan was considered a significant MLS.
The authors found that the biggest difference between CT MLS and TCS MLS was 0.2 cm. This was likely because the absence of cranium makes the ultrasound penetrate intracerebral contents with ease and gives a clear, high-resolution picture. The the correlation (r2) using Pearson's correlation coefficient between CT and TCS was 0.99 and P value of <0.00001. ICC calculated between CT-MLS and TCS MLS was 0.996, indicating an almost perfect agreement. Significant MLS was detected in 24/31 of the patients, which showed that the ability to detect significant MLS was good. The study showed that even with the limitations, it has the ability to detect a significant MLS in decompressive craniectomy patients. Although CT Brain is considered as the gold standard in assessing the prognosis of the patient in decompressive craniectomy, the TCS provides an alternative method to serial CT scans.
TCS definitely is useful in assessing MLS after the initial CT and is definitely a substitute for serial CT scans. The current study has shown that TCS can measure MLS with high accuracy and can serve as a valuable bedside tool to monitor intracerebral lesions. The authors hope that it would pave the way for further studies with large sample sizes and different intracerebral parameters as well as encourage neurocritical care specialists to utilize this bedside tool.
Reference
Maramattom, Boby V.; Abraham, Mathew; Sundararajan, Ananthram. Assessment of Midline Shift in Postdecompressive Craniectomy Patients in Neurocritical Care: Comparison between Transcranial Ultrasonography and Computerized Tomography. Neurology India 71(6):p 1167-1171, Nov–Dec 2023. | DOI: 10.4103/0028-3886.391386
MBBS, DrNB Neurosurgery
Krishna Shah, MBBS, DrNB Neurosurgery. She did her MBBS from GMC, Jamnagar, and there after did direct 6 Year DrNB Neurosurgery from Sir Ganga Ram Hospital, Delhi. Her interests lie in Brain and Spine surgery, Neurological disorders, minimally invasive surgeries, Endoscopic brain and spine procedures, as well as research.
Dr Kamal Kant Kohli-MBBS, DTCD- a chest specialist with more than 30 years of practice and a flair for writing clinical articles, Dr Kamal Kant Kohli joined Medical Dialogues as a Chief Editor of Medical News. Besides writing articles, as an editor, he proofreads and verifies all the medical content published on Medical Dialogues including those coming from journals, studies,medical conferences,guidelines etc. Email: drkohli@medicaldialogues.in. Contact no. 011-43720751