Kernohan's notch phenomenon in chronic subdural hematoma: MRI findings.
We report two cases of Kernohan's notch phenomenon secondary to chronic subdural hematoma detected by MRI. In the first case, the patient was drowsy with an oculomotor palsy and a hemiparesis ipsilateral to the chronic subdural hematoma. MRI in the post-operative period showed no abnormal signal or deformity of the crus cerebri. The neurological signs immediately resolved after trephination. In the second case, the patient was admitted with progressive decrease in their level of consciousness and ipsilateral hemiparesis with the chronic subdural hematoma. MRI on admission revealed an abnormal signal in the contralateral crus cerebri against the chronic subdural hematoma. After surgery, the mental state gradually recovered to normal with some degree of residual hemiparesis. In patients with chronic subdural hematoma, a compressive deformity of the crus cerebri, without abnormal signal on MRI, may predict a better neurological recovery in patients with Kernohan's notch phenomenon.
Moon
Kyung-Sub
KS
Department of Neurosurgery, Chonnam National University Hospital and Medical School, 8 Hack-Dong, Dong-Ku, 501-757, Gwangju, Korea.
Lee
Jung-Kil
JK
Joo
Sung-Pil
SP
Kim
Tae-Sun
TS
Jung
Shin
S
Kim
Jae-Hyoo
JH
Kim
Soo-Han
SH
Kang
Sam-Suk
SS
D000368:Aged; D020208:Brain Injury, Chronic / Q000209:etiology* / Q000473:pathology* / Q000503:physiopathology; D002908:Chronic Disease; D003399:Craniotomy; D042241:Early Diagnosis; D005260:Female; D006408:Hematoma, Subdural / Q000150:complications* / Q000473:pathology* / Q000503:physiopathology; D006801:Humans; D019586:Intracranial Hypertension / Q000150:complications; D008279:Magnetic Resonance Imaging; D008297:Male; D008636:Mesencephalon / Q000293:injuries* / Q000473:pathology* / Q000503:physiopathology; D008875:Middle Aged; D009434:Neural Pathways / Q000293:injuries / Q000473:pathology / Q000503:physiopathology; D015840:Oculomotor Nerve Diseases / Q000209:etiology / Q000473:pathology / Q000503:physiopathology; D010291:Paresis / Q000209:etiology / Q000473:pathology / Q000503:physiopathology; D011237:Predictive Value of Tests; D013681:Tegmentum Mesencephali / Q000293:injuries / Q000473:pathology / Q000503:physiopathology; D014057:Tomography, X-Ray Computed