Lateral Ventricle Volume Asymmetry Predicts Midline Shift in Severe Traumatic Brain Injury

Arnold Tóth, Ilona Schmalfuss, Shelley C. Heaton, Andrea Gabrielli, H. Julia Hannay, Linda Papa, Gretchen M. Brophy, Kevin K.W. Wang, András Büki, Attila Schwarcz, Ronald L. Hayes, Claudia S. Robertson, Steven A. Robicsek

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4 Citations (Scopus)


Midline shift following severe traumatic brain injury (sTBI) detected on computed tomography (CT) scans is an established predictor of poor outcome. We hypothesized that lateral ventricular volume (LVV) asymmetry is an earlier sign of developing asymmetric intracranial pathology than midline shift. This retrospective analysis was performed on data from 84 adults with blunt sTBI requiring a ventriculostomy who presented to a Level I trauma center. Seventy-six patients underwent serial CTs within 3h and an average of three scans within the first 10d of sTBI. Left and right LVVs were quantified by computer-assisted manual volumetric measurements. LVV ratios (LVR) were determined on the admission CT to evaluate ventricular asymmetry. The relationship between the admission LVR value and subsequent midline shift development was tested using receiver operating characteristic (ROC) analysis, and odds ratio (OR) and relative risk tests. Sixty patients had no >5mm midline shift on the initial admission scan. Of these, 15 patients developed it subsequently (16 patients already had >5mm midline shift on admission scans). For >5mm midline shift development, admission LVR of >1.67 was shown to have a sensitivity of 73.3% and a specificity of 73.3% (area under the curve=0.782; p<0.0001). LVR of >1.67 as exposure yielded an OR of 7.56 (p<0.01), and a risk ratio of 4.42 (p<0.01) for midline shift development as unfavorable outcome. We propose that LVR captures LVV asymmetry and is not only related to, but also predicts the development of midline shift already at admission CT examination. Lateral ventricles may have a higher "compliance" than midline structures to developing asymmetric brain pathology. LVR analysis is simple, rapidly accomplished and may allow earlier interventions to attenuate midline shift and potentially improve ultimate outcomes.

Original languageEnglish
Pages (from-to)1307-1311
Number of pages5
JournalJournal of Neurotrauma
Issue number17
Publication statusPublished - Sep 1 2015


  • computed tomography
  • midline shift
  • traumatic brain injury
  • ventricle

ASJC Scopus subject areas

  • Clinical Neurology

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    Tóth, A., Schmalfuss, I., Heaton, S. C., Gabrielli, A., Hannay, H. J., Papa, L., Brophy, G. M., Wang, K. K. W., Büki, A., Schwarcz, A., Hayes, R. L., Robertson, C. S., & Robicsek, S. A. (2015). Lateral Ventricle Volume Asymmetry Predicts Midline Shift in Severe Traumatic Brain Injury. Journal of Neurotrauma, 32(17), 1307-1311.