Assessment of brain midline shift using transcranial ultrasonography in severe traumatic brain injury: comparative study with computed tomography

Abstract

Introduction Severe traumatic brain injury (TBI), defined as head trauma associated with a Glasgow Coma Scale score of 3–8, is a major and challenging problem in critical care medicine. TBI has a broad spectrum of severity, pathology, physiology, and sequelae. Because of this, there are numerous ways in which to describe and classify TBI. Cerebral ischemia is considered the single most important secondary event affecting outcomes following severe TBI. Computed tomography (CT) is considered to be the gold standard to diagnose midline shift (MLS); serial CTs in neurosurgical ICU patients can be associated with significant morbidity and secondary brain injuries posttransfer related to their transport. Transcranial Doppler is a noninvasive method to measure cerebral blood flow velocity. It is a clinically useful tool in the diagnosis of complications that may occur in patients with TBI. Objective This work aimed to monitor the effect of hyperosmolar solutions on brain MLS by using transcranial ultrasonography (TCUS) in severe TBI. Patients and methods This study was an observational comparative prospective cohort study that was done in the Critical Care Department of Alexandria University Hospitals on 60 patients with severe TBI. The ultrasound MLS was measured through the temporal acoustic bone and was compared by two methods of assessment by CT. Results In the current study, there was a positive correlation between acute physiology and chronic health evaluation II and ICU stay and mortality. We also found that brain edema, MLS, and Glasgow Coma Score were improved after the use of hyperosmolar solution. The most important finding in this study was that TCUS could detect and monitor MLS with only a small difference in comparison to CT brain, so it provides a cheap, accurate noninvasive, and bedside tool for diagnosis and monitoring MLS. Conclusion This study suggests that TCUS is comparable to CT (the cornerstone tool in neuroimaging) in early diagnosis and follow-up of MLS in severe TBI after using hyperosmolar solutions.