title: Can midline brain shift be used as a prognostic factor to predict postoperative restoration of consciousness in patients with chronic subdural hematoma?
abstract: OBJECTIVE
  Our aim was to determine if midline brain shift could be used as a prognostic factor to predict postoperative restoration of consciousness in patients with CSDH. In these patients, we evaluated the relation (1) between midline brain shift as measured on CT and alteration of level of consciousness, and (2) between midline brain shift and restoration of consciousness after the operation.
  
  
  METHODS
  Prospectively recorded data of 45 patients with CSDH were evaluated. We compared level of consciousness of patients measured by GCS score, brain displacement at PG and SP both in the preoperative and early postoperative period.
  
  
  RESULTS
  Preoperatively, PG and SP shifts of the patients who were alert (GCS = 15) were significantly less than those of patients who had diminished consciousness. However, in patients with diminished consciousness (GCS < 15), the amount of lateral brain displacement and the degree of diminution of consciousness did not correlate. Those patients who had a preoperative SP shift of less than 10 mm had a significantly lesser chance to become alert after operation (2 of 5 patients) when compared with those patients who had a preoperative SP shift of 10 mm or more (21 of 23 patients).
  
  
  CONCLUSIONS
  We conclude that preoperative SP shift may be used as a factor to predict restoration of consciousness in patients with CSDH; the likelihood of becoming alert after operation is increased if SP shift is 10 mm or greater, and is decreased if SP shift is less than 10 mm.
authors.affiliation: Neurosurgery Department, Izmir Atatürk Training and Research Hospital, Izmir 35360, Turkey. hsucu@yahoo.com
authors.forename: Hasan Kamil
authors.initials: HK
authors.lastname: Sucu
authors.forename: Fazil
authors.initials: F
authors.lastname: Gelal
authors.forename: Metin
authors.initials: M
authors.lastname: Gökmen
authors.forename: Füsun Demirçivi
authors.initials: FD
authors.lastname: Ozer
authors.forename: Sevket
authors.initials: S
authors.lastname: Tektaş
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001921:Brain / Q000000981:diagnostic imaging* / Q000503:physiopathology / Q000601:surgery; D003244:Consciousness Disorders / Q000000981:diagnostic imaging* / Q000209:etiology / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D020200:Hematoma, Subdural, Chronic / Q000000981:diagnostic imaging* / Q000523:psychology / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D011859:Radiography; D020127:Recovery of Function; D016896:Treatment Outcome