Midline shift is a shift of the brain past its center line.

Immediate surgery may be indicated when there is a midline shift of over 5 mm.

Three main structures are commonly investigated when measuring midline shift.

Prognosis is much worse in patients with midline shift than in those without it.

Midline shift can compress the ventricles and lead to hydrocephalus.

Midline shift is often associated with high intracranial pressure (ICP), which can be deadly.

Presence of midline shift is an indication for neurosurgeons to take measures to monitor and control ICP.

In fact, midline shift is a measure of ICP; presence of the former is an indication of the latter.

The hematoma can exert a mass effect on the brain, increasing intracranial pressure and potentially causing midline shift or deadly brain herniation.

Identifying the location of these structures on a damaged brains compared to an unaffected brain is another way of categorizing the severity of the midline shift.

Since the midline shift is often easily visible with a CT scan, the high precision of Magnetic Resonance Imaging (MRI) is not necessary, but can be used with equally adequate results.