An 82 year old man developed the confusion after a fall. Within a few days, he developed a language disturbance and mild right hemiplegia. the next day, he lapsed into coma and displayed decerebrate posturing.

CT scan of the brain at the level of the Basal Ganglia. Note the sudural hematoma on the left extending down to the tentorium. There is a resulting midline shift. When a line is drawn down the midline, the amount of horizontal shift can be measured. In this case, there is a 10.8 mm shift of midline (note the septum pellicidum should be in the midline. This amount of shift is usually associated with coma and impending herniation.

Revised 04/20/06.
The Electronic Curriculum is copyrighted 1998,  Case Western Reserve University School of Medicine.