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Carrasco Moro R, Pascual Garvi JM, Vior Fernández C, Espinosa Rodríguez EE, Martín Palomeque G, Cabañes Martínez L, López Gutiérrez M, Acitores Cancela A, Barrero Ruiz E, Martínez San Millán JS. Kernohan-Woltman notch phenomenon: an exceptional neurological picture? Neurologia 2024; 39:683-693. [PMID: 36396093 DOI: 10.1016/j.nrleng.2022.09.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 09/15/2022] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION Ipsilateral hemiparesis (IH) can be defined as a paradoxical dysfunction of the first motor neuron involving the extremities on the opposite side to that expected, given the location of the triggering intracranial pathology. Compression of the corticospinal tract (CSt) along its course through the contralateral cerebral peduncle against the free edge of the tentorium, known as the Kernohan-Woltman notch phenomenon (KWNP), represents the main cause of IH. METHODS This retrospective study analyses a series of 12 patients diagnosed with IH secondary to KWNP treated at our institution, including a descriptive study of epidemiological, clinical, radiological, neurophysiological, and prognostic variables. RESULTS In 75% of the cases, symptoms had an acute or subacute onset. Initial imaging studies showed signs of significant mass effect in half of the patients, whereas magnetic resonance imaging (MRI) identified a structural lesion in the contralateral cerebral peduncle in two thirds of them. Impairment of the motor evoked potentials (MEP) was verified in 4 patients. During follow-up 7 patients experienced improvement in motor activity, and near half of the cases were classified in the first three categories of the modified Rankin scale. CONCLUSIONS In contrast to prior historical series, most of our patients developed a KWNP secondary to a traumatic mechanism. MRI represents the optimal method to identify both the classic cerebral peduncle notch and the underlying structural lesion of the CSt. The use of MEP can help to establish the diagnosis, especially in those cases lacking definite radiological findings.
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Affiliation(s)
- R Carrasco Moro
- Servicio de Neurocirugía, Hospital Universitario Ramón y Cajal, Madrid, Spain.
| | - J M Pascual Garvi
- Servicio de Neurocirugía, Hospital Universitario La Princesa, Madrid, Spain
| | - C Vior Fernández
- Servicio de Neurocirugía, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | | | - G Martín Palomeque
- Servicio de Neurofisiología Clínica, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - L Cabañes Martínez
- Servicio de Neurofisiología Clínica, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - M López Gutiérrez
- Servicio de Neurocirugía, Hospital Central de la Defensa Gómez Ulla, Madrid, Spain
| | - A Acitores Cancela
- Servicio de Neurocirugía, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - E Barrero Ruiz
- Servicio de Neurocirugía, Hospital Universitario Ramón y Cajal, Madrid, Spain
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Beucler N. In Reply to the Letter to the Editor Regarding "Kernohan-Woltman Notch Phenomenon Following Acute Subdural Hematoma". World Neurosurg 2024; 188:244-247. [PMID: 39010339 DOI: 10.1016/j.wneu.2024.05.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2024] [Accepted: 05/07/2024] [Indexed: 07/17/2024]
Affiliation(s)
- Nathan Beucler
- Neurosurgery Department, Sainte-Anne Military Teaching Hospital, Toulon, France.
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Carrasco-Moro R, Pascual JM. Commentary on: Chang K, Vincenti DM, Troncoso JC. Temporal lobe uncal herniation with contralateral superior cerebellar artery infarct. J Forensic Sci. 2024;69(1):337-40. https://doi.org/10.1111/1556-4029.15382. J Forensic Sci 2024; 69:1512-1515. [PMID: 38691104 DOI: 10.1111/1556-4029.15535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Accepted: 04/17/2024] [Indexed: 05/03/2024]
Affiliation(s)
| | - José M Pascual
- Department of Neurosurgery, La Princesa University Hospital, Madrid, Spain
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Carrasco-Moro R, Martínez-San Millán JS, Pascual JM. Beyond uncal herniation: An updated diagnostic reappraisal of ipsilateral hemiparesis and the Kernohan-Woltman notch phenomenon. Rev Neurol (Paris) 2023; 179:844-865. [PMID: 36907707 DOI: 10.1016/j.neurol.2022.11.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Revised: 11/23/2022] [Accepted: 11/25/2022] [Indexed: 03/12/2023]
Abstract
PURPOSE This works comprehensively analyses a modern cohort of patients with ipsilateral hemiparesis (IH) and discusses the pathophysiological theories elaborated to explain this paradoxical neurological sign according to the findings from contemporary neuroimaging and neurophysiological techniques. METHODS A descriptive analysis of the epidemiological, clinical, neuroradiological, neurophysiological, and outcome data in a series of 102 case reports of IH published on since the introduction of CT/MRI diagnostic methods (years 1977-2021) was performed. RESULTS IH mostly developed acutely (75.8%) after traumatic brain injury (50%), as a consequence of the encephalic distortions exerted by an intracranial haemorrhage eventually causing contralateral peduncle compression. Sixty-one patients developed a structural lesion involving the contralateral cerebral peduncle (SLCP) demonstrated by modern imaging tools. This SLCP showed certain variability in its morphology and topography, but it seems pathologically consistent with the lesion originally described in 1929 by Kernohan & Woltman. The study of motor evoked potentials was seldom employed for the diagnosis of IH. Most patients underwent surgical decompression, and a 69.1% experienced some improvement of the motor deficit. CONCLUSIONS Modern diagnostic methods support that most cases in the present series developed IH following the KWNP model. The SLCP is presumably the consequence of either compression or contusion of the cerebral peduncle against the tentorial border, although focal arterial ischemia may also play a contributing role. Some improvement of the motor deficit should be expected even in the presence of a SLCP, provided the axons of the CST were not completely severed.
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Affiliation(s)
- R Carrasco-Moro
- Department of Neurosurgery, Ramón y Cajal U, Comenar Rd., Km. 9.100, Madrid, Spain.
| | | | - J M Pascual
- Department of Neurosurgery, La Princesa U. H, Madrid, Spain
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Murhega RB, Balemba Ghislain M, Mudekereza PS, Musilimu S, Bisimwa I, Munguakonkwa Budema P, Mubenga L. Kernohan-Woltman notch phenomenon in patient with subdural hematoma and ipsilateral hemiparesis in Bukavu. Clin Case Rep 2023; 11:e7643. [PMID: 37415583 PMCID: PMC10319946 DOI: 10.1002/ccr3.7643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Revised: 11/12/2022] [Accepted: 06/23/2023] [Indexed: 07/08/2023] Open
Abstract
Key Clinical Message Kernohan-Woltman phenomenon is a rare and paradoxical neurological situation in which a transtentorial lesion leads to compression of the contralateral cerebral peduncle responsible for compression of the descending corticospinal fibers with clinical consequence of a motor deficit ipsilateral to the primary lesion. This phenomenon should attract the attention of clinicians in order to avoid unfortunate incidents such as wrong-side craniotomy in neurosurgical practice. In this work, we report a similar situation. Abstract The Kernohan-Woltman notch phenomenon is a rare and paradoxical neurological situation in which transtentorial damage is observed leading to compression of the contralateral cerebral peduncle responsible for compression of descending corticospinal fibers with the clinical consequence of a motor deficit ipsilateral to the primary lesion. This phenomenon has been found in several situations including tumors and cerebral hematomas after craniocerebral trauma. In this work, we have reported the case of a 52-year-old man with hemiparesis ipsilateral to a large chronic subdural hematoma.
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Affiliation(s)
- Roméo Bujiriri Murhega
- Department of SurgeryProvincial General Reference Hospital of BukavuBukavuDemocratic Republic of Congo
- Faculty of MedicineUniversité Catholique de BukavuBukavuDemocratic Republic of Congo
- Department of NeurosurgeryNational Hospital of NiameyNiameyNiger
| | - Maheshe Balemba Ghislain
- Department of SurgeryProvincial General Reference Hospital of BukavuBukavuDemocratic Republic of Congo
- Department of RadiologyProvincial General Reference Hospital of BukavuBukavuDemocratic Republic of Congo
| | - Paterne Safari Mudekereza
- Department of SurgeryProvincial General Reference Hospital of BukavuBukavuDemocratic Republic of Congo
- Faculty of MedicineUniversité Catholique de BukavuBukavuDemocratic Republic of Congo
| | - Sudi Musilimu
- Department of SurgeryProvincial General Reference Hospital of BukavuBukavuDemocratic Republic of Congo
- Faculty of MedicineUniversité Catholique de BukavuBukavuDemocratic Republic of Congo
| | - Igega Bisimwa
- Department of SurgeryProvincial General Reference Hospital of BukavuBukavuDemocratic Republic of Congo
- Faculty of MedicineUniversité Catholique de BukavuBukavuDemocratic Republic of Congo
| | - Paul Munguakonkwa Budema
- Department of SurgeryProvincial General Reference Hospital of BukavuBukavuDemocratic Republic of Congo
- Faculty of MedicineUniversité Catholique de BukavuBukavuDemocratic Republic of Congo
| | - Léon‐Emmanuel Mubenga
- Department of SurgeryProvincial General Reference Hospital of BukavuBukavuDemocratic Republic of Congo
- Faculty of MedicineUniversité Catholique de BukavuBukavuDemocratic Republic of Congo
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Beucler N, Cungi PJ, Baucher G, Coze S, Dagain A, Roche PH. The Kernohan-Woltman Notch Phenomenon : A Systematic Review of Clinical and Radiologic Presentation, Surgical Management, and Functional Prognosis. J Korean Neurosurg Soc 2022; 65:652-664. [PMID: 35574584 PMCID: PMC9452377 DOI: 10.3340/jkns.2022.0002] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Accepted: 02/26/2022] [Indexed: 11/27/2022] Open
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False lateralazing sign in skull base tumor a case series of five patients. INTERDISCIPLINARY NEUROSURGERY 2021. [DOI: 10.1016/j.inat.2021.101340] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Superficial anatomy of the neonatal cerebrum - an ultrasonographic roadmap. Pediatr Radiol 2021; 51:353-370. [PMID: 33026469 PMCID: PMC7897227 DOI: 10.1007/s00247-020-04794-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 07/06/2020] [Accepted: 08/04/2020] [Indexed: 10/23/2022]
Abstract
Neurosonography is an essential imaging modality for assessing the neonatal brain, particularly as a screening tool to evaluate intracranial hemorrhage, hydrocephalus and periventricular leukomalacia. The primary advantages of neurosonography include portability, accessibility and lack of ionizing radiation. Its main limitations are intrinsic operator dependence and the need for an open fontanelle. Neurosonographic imaging acquisition is typically performed by placing a sector transducer over the anterior fontanelle and following sagittal and coronal sweeps. The sensitivity of neurosonography has markedly improved thanks to the adoption of modern imaging equipment, the use of dedicated head probes, and the employment of advanced diagnostic US techniques. These developments have facilitated more descriptive identification of specific cerebral anatomical details, improving understanding of the cerebral anatomy by conventional US. Such knowledge is fundamental for enhanced diagnostic sensitivity and is a key to understanding pathological states. Furthermore, familiarity with normal anatomy is crucial for understanding pathological states. Our primary goal in this review was to supplement these technological developments with a roadmap to the cerebral landscape. We accomplish this by presenting a systematic approach to using routine US for consistent identification of the most crucial cerebral landmarks, reviewing their relationship with adjacent structures, and briefly describing their primary function.
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Kernohan-Woltman Notch Phenomenon in Two Patients with Subdural Hematoma and Ipsilateral Hemiparesis. Am J Phys Med Rehabil 2020; 99:1195-1196. [DOI: 10.1097/phm.0000000000001427] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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An unusual case of waterskiing-related acute subdural hematoma in an adolescent treated with endoscopic assisted hematoma evacuation. INTERDISCIPLINARY NEUROSURGERY 2019. [DOI: 10.1016/j.inat.2019.100478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Carrasco-Moro R, Castro-Dufourny I, Martínez-San Millán JS, Cabañes-Martínez L, Pascual JM. Ipsilateral hemiparesis: the forgotten history of this paradoxical neurological sign. Neurosurg Focus 2019; 47:E7. [DOI: 10.3171/2019.6.focus19337] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Accepted: 06/12/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVEEstablishing the neurological localization doctrine for the contralateral hemispheric control of motor functions in the second half of the 19th century, researchers faced the challenge of recognizing false localizing signs, in particular paradoxical or ipsilateral hemiparesis (IH). Despite tremendous progress in current methods of neuroradiological and electrophysiological exploration, a complete understanding of this phenomenon has yet to be attained.METHODSThe authors researched the well-described cases of hemiparesis/hemiplegia ipsilateral to an intracranial lesion published in the scientific literature in the pre-MRI era (before 1980). A comprehensive review of the physiopathological mechanisms proposed for paradoxical hemiparesis throughout this period, as well as the pathological evidence substantiating them, is provided.RESULTSA collection of 75 patients with hemiparesis/hemiplegia ipsilateral to the primary intracranial lesion reported between 1858 and 1979 were eligible for analysis. Most cases occurred in adults with supratentorial, slowly developing, extraparenchymatous mass lesions, such as neoplasms (38%) or chronic subdural hematomas (36%). Physiopathological theories proposed by the neurologists who investigated IH can be grouped into 4 major concepts: 1) lack of anatomical decussation of the corticospinal tract; 2) impaired functional activation of the contralateral hemisphere by the lesioned dominant hemisphere through the callosal connections; 3) Kernohan’s notch phenomenon, or mechanical injury of the contralateral cerebral peduncle against the free edge of the tentorium; and 4) cerebrovascular dysfunction involving the contralateral hemisphere owing to kinking and mechanical flattening of the carotid artery contralateral to the primary intracranial lesion.CONCLUSIONSIH represents a still underdiagnosed paradoxical neurological phenomenon. With the aid of modern neuroradiological and neurophysiological methods, Kernohan’s peduncle notch mechanism has been confirmed to cause IH in many of the cases reported in recent decades. Nevertheless, alternative functional and/or vascular mechanisms must be investigated further for unexplained IH cases, in particular for transitory IH without evidence of peduncle injury. The historical theories reviewed in this paper represent a conceptual framework that may be helpful for this purpose.
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Affiliation(s)
| | - Ines Castro-Dufourny
- 2Department of Endocrinology, Sureste University Hospital, Francisco de Vitoria University
| | | | | | - José M. Pascual
- 5Department of Neurosurgery, La Princesa University Hospital, Madrid, Spain
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Chen PY, Chen TY, Lee YC, Liliang PC. Kernohan-Woltman Notch Phenomenon Caused by Acute Traumatic Subdural Haematoma. HONG KONG J EMERG ME 2017. [DOI: 10.1177/102490791402100204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
A 27-year-old man suffered from right hemiparesis after a closed head injury. Computed tomography (CT) revealed a right hemisphere subdural haematoma with midline structure shifted to the left. The CT finding was believed to be mislabeled because the site of haematoma did not correlate with an ipsilateral hemiparesis. Magnetic resonance imaging revealed a right transtentorial uncal herniation and a small lesion within left cerebral peduncle, suggesting Kernohan-Woltman notch phenomenon (KWNP). KWNP has been rarely seen in patients with acute traumatic subdural haemorrhage. Anatomical small maximum tentorial notch width is the possible anatomical factor predisposing our patient to this phenomenon. (Hong Kong j.emerg.med. 2014;21:116-119)
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Affiliation(s)
| | | | - YC Lee
- E-Da Hospital, I-Shou University, Department of Radiology, Kaohsiung, Taiwan
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Stone JL, Bailes JE, Hassan AN, Sindelar B, Patel V, Fino J. Brainstem Monitoring in the Neurocritical Care Unit: A Rationale for Real-Time, Automated Neurophysiological Monitoring. Neurocrit Care 2017; 26:143-156. [PMID: 27484878 DOI: 10.1007/s12028-016-0298-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Patients with severe traumatic brain injury or large intracranial space-occupying lesions (spontaneous cerebral hemorrhage, infarction, or tumor) commonly present to the neurocritical care unit with an altered mental status. Many experience progressive stupor and coma from mass effects and transtentorial brain herniation compromising the ascending arousal (reticular activating) system. Yet, little progress has been made in the practicality of bedside, noninvasive, real-time, automated, neurophysiological brainstem, or cerebral hemispheric monitoring. In this critical review, we discuss the ascending arousal system, brain herniation, and shortcomings of our current management including the neurological exam, intracranial pressure monitoring, and neuroimaging. We present a rationale for the development of nurse-friendly-continuous, automated, and alarmed-evoked potential monitoring, based upon the clinical and experimental literature, advances in the prognostication of cerebral anoxia, and intraoperative neurophysiological monitoring.
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Affiliation(s)
- James L Stone
- Department of Neurosurgery, NorthShore University HealthSystem, Evanston, IL, USA. .,Departments of Neurology and Neurological Surgery, University of Illinois at Chicago, Chicago, IL, USA. .,Division of Neurosurgery, Department of Surgery, Cook County Stroger Hospital, Chicago, IL, USA.
| | - Julian E Bailes
- Department of Neurosurgery, NorthShore University HealthSystem, Evanston, IL, USA
| | - Ahmed N Hassan
- Departments of Neurology and Neurological Surgery, University of Illinois at Chicago, Chicago, IL, USA
| | - Brian Sindelar
- Department of Neurosurgery, NorthShore University HealthSystem, Evanston, IL, USA.,Department of Neurosurgery, University of Florida, Gainesville, FL, USA
| | - Vimal Patel
- Department of Neurosurgery, NorthShore University HealthSystem, Evanston, IL, USA
| | - John Fino
- Departments of Neurology and Neurological Surgery, University of Illinois at Chicago, Chicago, IL, USA
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Zhang CH, DeSouza RM, Kho JSB, Vundavalli S, Critchley G. Kernohan–Woltman notch phenomenon: a review article. Br J Neurosurg 2016; 31:159-166. [DOI: 10.1080/02688697.2016.1211250] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- C. H. Zhang
- Department of Neurosurgery, Royal Sussex County Hospital, Brighton, United Kingdom
| | - R. M. DeSouza
- Department of Neurosurgery, Royal Sussex County Hospital, Brighton, United Kingdom
| | - J. S. B. Kho
- Department of Neuroradiology, Royal Sussex County Hospital, Brighton, United Kingdom
| | - S. Vundavalli
- Department of Neuroradiology, Royal Sussex County Hospital, Brighton, United Kingdom
| | - G. Critchley
- Department of Neurosurgery, Royal Sussex County Hospital, Brighton, United Kingdom
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Dammers R, Volovici V, Kompanje EJ. In Reply. Neurosurgery 2016; 79:E546-7. [DOI: 10.1227/neu.0000000000001364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Some Considerations on the Kernohan–Woltman Notch Phenomenon. Clin Neuroradiol 2015; 25:437-8. [DOI: 10.1007/s00062-015-0424-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2015] [Accepted: 06/10/2015] [Indexed: 10/23/2022]
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Carrasco-Moro R, Pascual-Garvi JM. [Some considerations on the Kernohan-Woltman phenomenon]. REVISTA ESPANOLA DE ANESTESIOLOGIA Y REANIMACION 2014; 61:587-588. [PMID: 24746359 DOI: 10.1016/j.redar.2014.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/31/2013] [Revised: 02/28/2014] [Accepted: 03/04/2014] [Indexed: 06/03/2023]
Affiliation(s)
- R Carrasco-Moro
- Servicio de Neurocirugía, Hospital Universitario Ramón y Cajal, Madrid, España.
| | - J M Pascual-Garvi
- Servicio de Neurocirugía, Hospital Universitario La Princesa, Madrid, España
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Carrasco-Moro R, Abreu-Calderón F, de Blas-Beorlegui G, Pascual J, Ley-Urzaiz L. Fenómeno de Kernohan-Woltman. Rev Clin Esp 2014; 214:e97-9. [DOI: 10.1016/j.rce.2014.05.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2014] [Accepted: 05/03/2014] [Indexed: 01/06/2023]
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Ohn SH. Motor Symptoms in Brain Stem Lesion. BRAIN & NEUROREHABILITATION 2014. [DOI: 10.12786/bn.2014.7.2.101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Affiliation(s)
- Suk Hoon Ohn
- Department of Physical Medicine and Rehabilitation, Hallym University College of Medicine, Korea
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[Kernohan-Woltman notch phenomenon secondary to a cranial epidural hematoma]. ACTA ACUST UNITED AC 2013; 61:332-5. [PMID: 23809681 DOI: 10.1016/j.redar.2013.05.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2013] [Revised: 04/24/2013] [Accepted: 05/02/2013] [Indexed: 11/20/2022]
Abstract
Kernohan-Woltman notch phenomenon is a paradoxical neurological manifestation which involves a motor deficit on the same side as the primary brain injury. It is produced mainly by acute or chronic subdural hematomas, and less frequently by post-traumatic epidural ones. It should be taken into consideration in cases of ipsilateral motor deficit, as it may lead to surgical procedures being performed on the incorrect side. We report the case of a 40 year old man who sustained a major head injury which was followed by a decreased level of consciousness and anisocoria. Computed tomography of the brain revealed a frontal and parietal epidural hematoma with right midline shift and uncal herniation. Craniotomy and drainage of the hematoma was performed, and on the sixth day after surgery it was observed that the patient had a brachio-crural right hemiparesis. Magnetic resonance imaging showed an ischemic area on the left capsule and cerebral peduncle consistent with the diagnosis of Kernohan-Woltman notch phenomenon.
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Tractography of persistent ipsilateral hemiparesis following subdural hematoma. Can J Neurol Sci 2013; 40:601-2. [PMID: 23786749 DOI: 10.1017/s031716710001475x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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