Brain hemorrhage 6h maximum midline shift. 4mm prompt for poor prognosis

Ref: Yang WS, et alNeurocrit Care2018 Jun;28 (3): 314-321doi: 10.1007/s112028-017-0483-7brain haemorrhage (ICH) have high erality and mortality ratesInitial hematoma volume combined with other factors, such as age, first CT showing in-brain hemorrhage, and hospital GCS scores, can predict the clinical prognosis of spontaneous ICHHematoma directly damages, compresses and stimulates brain tissue as the main cause of early brain damage; Measuring midline shift (midline shift, MLS) is an easy way to quantify the early occupating effect of ICHknown to all, MLS is associated with poor prognosis in patients with cerebral hemorrhage, but the MLS threshold associated with poor prognosis in early ich is not yet knownMoreover, the relationship between MLS and prognosis of hematoma in different parts is also differentWen-Song Yang of the Department of Neurology at Yongchuan Hospital, affiliated with Chongqing Medical University, studied the relationship between MLS and clinical prognosis in 6h of ICH onset, and determined the optimal MLS threshold for predicting adverse prognosis, the results of which were published in the June 2018 issue of Neurocrit Carethe study included 199 cases of cerebral hemorrhage with 6hThe researchers measured MLS in several different locations, including pineal gland regions, transparent partitions, and brain sicklesThe so-called maximum MLS is the largest mid-line shift in different partsThe improved Rankin scale (mRS) evaluation function prognosis was used 3 months after onsetMultivariate logistic regression analysis analyzes the correlation between MLS and prognosisRoc curve analysis was used to determine whether MLS could predict adverse outcomes 90 days after onsetresults showed that of 199 patients, 78 (39.2%) had poor prognosis at 3 months after onset Comparing patients with good prognosis (mRS 3) and poor prognosis (mRS 3), it was found that the MLS and the largest MLS in the pineal area, transparent partition and brain sickle of patients with good prognosis were less than the patients with poor prognosis, and the difference was statistically significant (P.001) adjusted age, GCS score at the time of admission, ICH site, time to initial CT, initial ICH volume and ventricular hemorrhage, the maximum MLS was independently associated with poor prognosis (OR,1.30; 95% CI, 1.02-1.65; P-0.032) The author suggests that the maximum MLS 4mm should be set as the optimal threshold, and that there is a significant difference between the maximum MLS and the maximum MLS 4mm prediction poor prognosis (P 0.001) the final author thinks that the maximum MLS in the 6h after ICH is a separate factor to predict the patient's functional prognosis, and the maximum MLS-4mm is the best threshold for judging poor prognosis (compiled by Lushan Na, editor-in-chief of "Outside Information" and editor-in-chief of Fudan University's affiliated Huashan Hospital
Professor Chen Jicheng ) related links