Transcranial Ultrasound Guided Assessment of Brain Midline Shift in Neuro Intensive Care Unit

Background: Neuro Intensive Care Unit (Neuro-ICU) handles neurological emergencies that involve intracranial (IC) hemorrhages. It can be challenging to manage elevated intracranial pressure (ICP) and midline shift (MLS), as they requires constant monitoring and frequent imaging. Trans-cranial Color Coded Sonography (TCCS), a bedside monitoring tool, may be helpful in monitoring MLS under such conditions. Objectives: To correlate MLS of the third ventricle in the brain measured by TCCS with CT midline shift. Method: A prospective observational study was conducted on patients with IC bleed who were mechanically ventilated and had a head CT done to rule out MLS. Within an hour of doing a CT brain, TCCS-MLS was identified. Data was collected and analyzed. Results: A total of fifty patients studied, the MLS (mean ±SD) was 5.3mm ± 3.1 mm using TCCS and 6.7±4.4 mm using CT brain. The calculated midline shift between TCCS and CT brain demonstrated a Pearson's correlation of 0.78 (P<0.001). With TCCS, the area under the ROC curve to identify a significant MLS was 0.91 (95%CI=0.8-1). TCCS-MLS of 3.9mm as a cut-off, predicted the occurrence of >5mm MLS on CT scan with a sensitivity of 95% and specificity of 90%. Conclusions: This study suggests that TCCS could serve as an alternative bedside monitoring tool in patients whose transportation is risky, in predicting the transcranial MLS >5mm with reasonable accuracy.