<% strPathPics = Session("strPathPicsL") imgBg = strPathPics + Session("strMedia") %> Midline Shift

Midline Shift and Impending Herniation

A 72 year old man developed the abrupt onset of a global aphasia, right hemiplegia, left gaze preference and right visual field loss. Two days later, he lapsed into coma and displayed decerebrate posturing.

Show the Infarction     Show the Amount of Midline Shift

CT scan of the brain at the level of the Basal Ganglia. Note the large infarction in the distribution of the left middle cerebral and posterior cerebral arteries. There is significant midline shift of the infarct with compression of the contralateral hemisphere. Also note the pineal gland which is calcified. The pineal should be directly in the midline. In  this case, it is shifted to the right. Such a picture denotes a grave prognosis.

Revised 05/19/06.
The Electronic Curriculum is copyrighted 1998,  Case Western Reserve University School of Medicine.