Kernohan-Woltman notch phenomenon caused by an acute subdural hematoma.
Uncal herniation through the tentorial notch is occasionally associated with false localizing ipsilateral hemiparesis, known as the Kernohan-Woltman notch phenomenon (KWNP). We report an 81-year-old female who presented with a decreased level of consciousness, a right mydriasis and an ipsilateral motor deficit caused by a large right hemispheric subdural hematoma that was immediately evacuated. The patient recovered well, although her right hemiplegia persisted. A follow-up MRI showed a residual lesion in the left cerebral peduncle, corresponding to KWNP. The presence of such a structural lesion suggests a poor prognosis for recovery from the initial motor deficit.
Carrasco
Rodrigo
R
Department of Neurosurgery, La Princesa University Hospital, C/- Diego de León 62, 28006 Madrid, Spain. rocamo@gmail.com
Pascual
José M
JM
Navas
Marta
M
Martínez-Flórez
Pedro
P
Manzanares-Soler
Rafael
R
Sola
Rafael G
RG
D000369:Aged, 80 and over; D005260:Female; D007839:Functional Laterality / Q000502:physiology*; D020199:Hematoma, Subdural, Acute / Q000150:complications*; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods; D013681:Tegmentum Mesencephali / Q000473:pathology*; D014057:Tomography, X-Ray Computed / Q000379:methods