Midline shift threshold value for hemiparesis in chronic subdural hematoma
Introduction. Chronic subdural hematoma (CSDH) has a variety of clinical presentations, with numerous neurological symptoms and signs. Hemiparesis is one of the leading signs that potentially indicates CSDH. Objective. Purpose of this study was to determine the threshold (cut-off) value of...
| Main Authors: | , |
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| Format: | Article |
| Language: | English |
| Published: |
Serbian Medical Society
2015-01-01
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| Series: | Srpski Arhiv za Celokupno Lekarstvo |
| Subjects: | |
| Online Access: | http://www.doiserbia.nb.rs/img/doi/0370-8179/2015/0370-81791508386J.pdf |
| Summary: | Introduction. Chronic subdural hematoma (CSDH) has a variety of clinical
presentations, with numerous neurological symptoms and signs. Hemiparesis is
one of the leading signs that potentially indicates CSDH. Objective. Purpose
of this study was to determine the threshold (cut-off) value of midsagittal
line (MSL) shift after which hemiparesis is likely to appear. Methods. The
study evaluated 83 patients with 53 unilateral and 30 bilateral CSDHs in
period of three years. Evaluated computed tomography (CT) findings in
patients with CSDH were diameter of the hematoma and midsagittal line shift,
measured on non-contrast CT scan in relation with occurrence of hemiparesis.
Threshold values of MSL shift for both types of CSDHs were obtained as
maximal (equal) sensitivity and specificity (intersection of the curves).
Results. MSL is a good predictor for hemiparesis occurrence (total sample,
AUROC 0.75, p=0.0001). Unilateral and bilateral CSDHs had different threshold
values of the MSL for hemiparesis development. Results suggested that in
unilateral CSDH the threshold values of MSL could be at 10 mm (AUROC=0.65;
p=0.07). For bilateral CSDH the threshold level of MSL shift was 4.5 mm
(AUROC=0.77; p=0.01). Conclusion. Our study pointed on the phenomenon that
midsagittal line shift can predict hemiparesis occurrence. Hemiparesis in
patients with bilateral CSDH was more related to midsagittal line shift
compared with unilateral CSDH. When value of midsagittal line shift exceed
the threshold level, hemiparesis occurs with certain probability. |
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| ISSN: | 0370-8179 2406-0895 |