Magnetic resonance imaging findings of Kernohan-Woltman notch in acute subdural hematoma.
OBJECTIVE
We report the case of a 73-year-old patient who presented a right motor deficit caused by an ipsilateral acute subdural hematoma. A magnetic resonance imaging (MRI) demonstration of Kernohan-Woltman notch phenomenon was obtained.


METHODS
The woman sustained a major head injury at home, followed by loss of consciousness. On admission to the emergency room, she was comatose, anisochoric (left > right), and showed a reaction to pain with decerebrating movements of left limbs (Glasgow Coma Scale (GCS) 4/15). A right severe hemiparesis was observed. Cerebral computed tomography scan showed a large right hemispheric subdural hematoma. INTERVENTION AND POST-OPERATIVE COURSE: A wide right craniotomy was performed and the subdural hematoma evacuated. During the post-operative period, the level of consciousness gradually improved. A MRI performed about 2 weeks after operation showed a small area of abnormal signal intensity in the left cerebral peduncle. On discharge, the woman was able to communicate with others, but her right hemiparesis was still severe.
Mastronardi
L
L
Sandro Pertini Hospital, Division of Neurosurgery, Roma, Italy. mastro@tin.it
Puzzilli
F
F
Ruggeri
A
A
Guiducci
A
A
D000368:Aged; D020208:Brain Injury, Chronic / Q000209:etiology*; D005260:Female; D016489:Head Injuries, Closed / Q000150:complications*; D020199:Hematoma, Subdural, Acute / Q000150:complications* / Q000473:pathology; D006429:Hemiplegia / Q000209:etiology / Q000473:pathology; D006801:Humans; D008279:Magnetic Resonance Imaging; D008636:Mesencephalon / Q000293:injuries / Q000473:pathology