A midline shift on CT in a TBI patient most directly indicates which condition?

• A. A midline shift indicates hydrocephalus.
• B. A midline shift indicates brain death.
• C. A midline shift indicates normal aging.
• D. A midline shift indicates mass effect from edema/hematoma; may require surgical decompression.

Answer: (D)

A midline shift on CT signals mass effect from swelling or a focal bleed that is pushing brain tissue across the midline. This displacement reflects raised intracranial pressure due to edema or hematoma, and it often requires urgent action to relieve pressure, such as surgical decompression or evacuation of the hematoma. It is not a sign of hydrocephalus, brain death, or normal aging—the shift specifically points to acute asymmetric pressure from a mass lesion.