Third ventricle midline shift due to spontaneous supratentorial intracerebral hemorrhage evaluated by transcranial color-coded sonography.
OBJECTIVE
We aimed to assess the clinical usefulness of the third ventricle midline shift (MLS) evaluated by transcranial color-coded sonography (TCCS) in acute spontaneous supratentorial intracerebral hemorrhage (ICH).


METHODS
Consecutive patients with acute (<24 hours after symptom onset) ICH were recruited for this TCCS study. Sonographic measurement of MLS and the pulsatility index (PI) of the middle cerebral arteries were compared with head computed tomographic (CT) data, including MLS, and hematoma volume. Poor functional outcome at 30 days after stroke onset was defined as modified Rankin scale greater than 2.


RESULTS
There were 51 patients with spontaneous supratentorial ICH who received CT and TCCS studies within a 12-hour window. Correlation between MLS by TCCS (mean +/- SD, 3.2 +/- 2.6 mm) and CT (3.0 +/- 2.4 mm) was high (gamma = 0.91; P < .01). There was also a good linear correlation between hematoma volume and MLS by TCCS (gamma = 0.81; P < .01). Compared with ICH volume less than 25 mL, those with greater volume had more severe MLS and a higher PI of the ipsilateral middle cerebral artery (P < .001). Midline shift by TCCS was more sensitive and specific than the PI in detecting large ICH (accuracy = 0.82 if MLS > or = 2.5 mm), and it was also a significant predictor of poor outcome (odds ratio, 2.09 by 1-mm increase; 95% confidence interval, 1.06-4.13).


CONCLUSIONS
Midline shift may be measured reliably by TCCS in spontaneous supratentorial ICH. Our study also showed that MLS on TCCS is a useful and convenient method to identify patients with large ICH and hematoma expansion and to predict short-term functional outcome.
Tang
Sung-Chun
SC
Stroke Center, National Taiwan University Hospital, Taipei.
Huang
Sheng-Jean
SJ
Jeng
Jiann-Shing
JS
Yip
Ping-Keung
PK
D002543:Cerebral Hemorrhage / Q000000981:diagnostic imaging*; D016009:Chi-Square Distribution; D005260:Female; D006801:Humans; D020244:Infarction, Middle Cerebral Artery / Q000000981:diagnostic imaging; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011673:Pulsatile Flow; D012680:Sensitivity and Specificity; D020542:Third Ventricle / Q000000981:diagnostic imaging* / Q000473:pathology; D014057:Tomography, X-Ray Computed; D017585:Ultrasonography, Doppler, Transcranial