Midline shift after severe head injury: Pathophysiologic implications

A. B. Valadka, S. P. Gopinath, C. S. Robertson, L. H. Pitts

Research output: Contribution to journalArticlepeer-review

38 Scopus citations


Objective: To investigate the mechanism of the adverse effect of midline shift after severe traumatic brain injury. Methods: This study compared averaged cerebral metabolic parameters of patients with midline shift > 5 mm (S) on initial computerized tomography scan to those of patients with shift ≤ 5 mm (NS). The effect of an acute subdural hematoma (SDH) was determined by separating patients into those with and those without SDH and then re-examining the effect of shift in these subgroups. Results: Four hundred fifty-four patients were studied. Cerebral metabolic rate of oxygen (CMRo2, in mL/100 g per min) was always lower with shift: 1.74 for SDH-S versus 2.21 for SDH-NS (p < 0.001), and 1.80 for non-SDH-S versus 2.24 for non-SDH-NS (p < 0.001). No other major effects of shift were seen in SDH patients. Among non-SDH patients, shift was associated with higher intracranial pressure (ICP): 23.1 mm Hg versus 16.3 mm Hg (p < 0.001). Other differences between shift and nonshift patients in the non-SDH group were due at least in part to interventions to treat the elevated ICP. Conclusion: Midline shift after severe traumatic brain injury is associated with reduced CMRo2, regardless of whether or not SDH is present. The deleterious effects of subdural blood may be related more to the mass effect of large SDHs than to the biochemical abnormalities caused by small amounts of blood in the subdural space.

Original languageEnglish (US)
Pages (from-to)1-10
Number of pages10
JournalJournal of Trauma - Injury, Infection and Critical Care
Issue number1
StatePublished - 2000
Externally publishedYes


  • Cerebral blood flow
  • Cerebral metabolic rate of oxygen
  • Head injury
  • Intracranial pressure
  • Midline shift
  • Subdural hematoma
  • Traumatic brain injury

ASJC Scopus subject areas

  • Surgery
  • Critical Care and Intensive Care Medicine


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