Hi everyone,
Would like your take on the concept of mass effect and midline shift please.
Would either of these effects be regarded as a normal consequence of an elected brain aneurysm clipping?
Also would you expect the physician to inform the patient that they had experienced mass effect and midline shift?
thank you,
all the best to you all
Dilys
Hey Dilys,
OK, so here is my understanding of 'midline shift' as explained to me by a neurologist. The brain has 2 halves, known as hemispheres. The hemispheres meet in the middle or midline, a bit like making to fists and bringing them together, as if to pray. The juncture of the fists is considered the midline. During a severe impact the brain can be jolted and move within the confines of the skull. This can compress neurons on one side of the brain and stretch neuron pathways on the other side. An object growing or expanding within the sealed area of the skull can cause a similar effect as the pressure moves the brain from the midline.
As for "...normal consequence of an elected brain aneurysm clipping?..." there would be many variables here. The size, position and method of treatment would all have an effect on this. IMO the 'mass effect' reasoning is often given when dr's have no idea of cause, as a mass effect can cover a bit of everything.
Merl
Dilys...you are asking a difficult questions...
First...because my records note "no midline shift"...and yah-de-yah...
My first logic is that any doc, especially a neuro-doc...should explain that potential to any patient before the procedure(s)...including which procedure... and, which one of those, would reduce the potential of mass effect or midline shift...and, why the doc is recommending which procedure...
Merl noted on 'mass-effect'...reasoning is often" given when dr's have no idea of cause"...and, yet those docs know the initial diagnoses before their procedure treatment.,..and, if they do NOT know the possible causes...should they be performing?
Merl said:
Hey Dilys,
OK, so here is my understanding of 'midline shift' as explained to me by a neurologist. The brain has 2 halves, known as hemispheres. The hemispheres meet in the middle or midline, a bit like making to fists and bringing them together, as if to pray. The juncture of the fists is considered the midline. During a severe impact the brain can be jolted and move within the confines of the skull. This can compress neurons on one side of the brain and stretch neuron pathways on the other side. An object growing or expanding within the sealed area of the skull can cause a similar effect as the pressure moves the brain from the midline.
As for "...normal consequence of an elected brain aneurysm clipping?..." there would be many variables here. The size, position and method of treatment would all have an effect on this. IMO the 'mass effect' reasoning is often given when dr's have no idea of cause, as a mass effect can cover a bit of everything.
Merl
Merl said:
Hey Dilys,
OK, so here is my understanding of 'midline shift' as explained to me by a neurologist. The brain has 2 halves, known as hemispheres. The hemispheres meet in the middle or midline, a bit like making to fists and bringing them together, as if to pray. The juncture of the fists is considered the midline. During a severe impact the brain can be jolted and move within the confines of the skull. This can compress neurons on one side of the brain and stretch neuron pathways on the other side. An object growing or expanding within the sealed area of the skull can cause a similar effect as the pressure moves the brain from the midline.
As for "...normal consequence of an elected brain aneurysm clipping?..." there would be many variables here. The size, position and method of treatment would all have an effect on this. IMO the 'mass effect' reasoning is often given when dr's have no idea of cause, as a mass effect can cover a bit of everything.
Merl
Thank you Merl,
When midline shift happens - is that something that you would expect a physician to tell you about when evidenced on post-op scans? I am assuming this could never be seen as a routine development given the consequences of midline shift post-op (and the monitoring involved) and potentially the longer-term. I understand this negatively impacts the patient and the causes include stroke or oedema from stroke. The aneurysm in question would be over 10mm and MCA located - and to emphasize an elected procedure.
patioplans said:
Dilys...you are asking a difficult questions...
First...because my records note "no midline shift"...and yah-de-yah...
My first logic is that any doc, especially a neuro-doc...should explain that potential to any patient before the procedure(s)...including which procedure... and, which one of those, would reduce the potential of mass effect or midline shift...and, why the doc is recommending which procedure...
Merl noted on 'mass-effect'...reasoning is often" given when dr's have no idea of cause"...and, yet those docs know the initial diagnoses before their procedure treatment.,..and, if they do NOT know the possible causes...should they be performing?
Thank you Patioplans
I agree!
When something like mass effect and midline shift occurs the patient should be informed that such a thing happened? Be it one of the risks or not?
Nothing is guaranteed but MCA clipping on an elected basis producing mass effect and 'moderate' midline shift - would that not be clinically significant not only in what the doctor needs to inform the patient, but potentially in terms of neuro-rehab?
Could that ever be regarded as a successful operation?
Dilys...I just typed away and 'lost it"... so starting over...
Your questions are somewhat complex...and, gets into what/when/where the appropriate coding was used: In your hospital admittance and discharge... which ones were provided to your insurance company "admittance" office (whatever their titles) ... You may have to request thru your insurance's legal department....and IF your hospital has not provided to you what they sent to the insurance company for payment..
And, then which codes are used on your "itemized" hospital billing records...and, the billings of the doctors...it is complex...to put them together in 'code' type, sequence, etc...
Finding (searching for?) what your doc couda/shouda done...can be searched in the CFR (Code of Fed Regs) I think as I type Title 21... may be more /less...and in each state's records on health care... whatever their title(s). ...
What is most important for me to ask you..is IF you have already asked your neuro doc and are satisfied w/his/her explanation...and, if you can/will share with us...
Dilys.....to qualify my last sentence(s) on the first paragraph.. "I your hospital has not provided to you what they sent to the insurance company for payment... "...
I did not clarify what was used on/for "diagnostic" code...and, then the status "discharge codes"...and which may be the same as, or diff from the diagnostic admittance...
and the itemized billing codes used during thru admittance and thru to discharge... (and/or in f/u sessions)