Midline shift (summary)

Last revised by Craig Hacking on 20 Nov 2018
This is a basic article for medical students and other non-radiologists

Midline shift is a finding described on transverse (axial) slices from CT and MRI studies. It describes the situation where the midline of the intracranial anatomy is no longer in the midline and is the result of pushing or pulling forces within either side of the intracranial compartment.

Reference article

This is a summary article; read more in our article on midline shift.

CT head | MRI brain

  • role of imaging
    • is there midline shift?
    • if it was present previously, is it worse?
    • what is the likely cause?
      • is there an acute cause that needs an immediate intervention?
    • who needs to know now?
  • radiographic features
    • midline structures should be in the midline
      • if they are not, pathology may be causing displacement
        • extra-axial collection
        • parenchymal mass lesion
        • parenchymal edema (secondary to underlying lesion)
    • parenchymal shift under the fibrous falx can cause injury
    • midline shift may obstruct the lateral ventricular outflow and result in secondary hydrocephalus

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Cases and figures

  • Figure 1: midline shift
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  • Case 1: extradural hematoma
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  • Case 2: subdural hematoma
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  • Case 3: glioblastoma
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  • Case 4: extensive midline shift from an acute SDH
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