title: Kernohan's notch and misdiagnosis of disorders of consciousness.
abstract: A 69-year-old man presented with a sudden headache followed by unconsciousness. There was no head injury. The Glasgow Coma Scale (GCS) score was 3/15 and there was a left mydriasis, unreactive to light. The CT-scan showed a left acute subdural haematoma causing a remarkable mass effect. A supratentorial hemispheric craniotomy was performed. Nevertheless, after several weeks at the intensive care unit (ICU), the patient was still unresponsive to external stimuli and did not show any motor activity. A comfort care attitude was decided on with the family and the patient was extubated. However, a few days later, the patient subsequently showed a surprisingly favourable course, with improved wakefulness. Indeed, the GCS score improved, and the treatment plan was modified so that the patient benefited from rehabilitation. The MRI showed a right cerebral peduncle lesion, consistent with a Kernohan-Woltman notch phenomenon (KWNP). Six months later, the patient was able to walk and live quite normally.
authors.affiliation: Departments of Neurosurgery and Clinical Neurosciences, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Suisse, Switzerland.
authors.forename: Alexandre
authors.initials: A
authors.lastname: Simonin
authors.forename: Marc
authors.initials: M
authors.lastname: Levivier
authors.forename: Sofia
authors.initials: S
authors.lastname: Nistor
authors.forename: Karin
authors.initials: K
authors.lastname: Diserens
mesh_terms: D000368:Aged; D015875:Anisocoria / Q000209:etiology; D003399:Craniotomy; D003951:Diagnostic Errors; D020199:Hematoma, Subdural, Acute / Q000150:complications / Q000175:diagnosis*; D006429:Hemiplegia / Q000209:etiology; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D015878:Mydriasis / Q000209:etiology; D013681:Tegmentum Mesencephali / Q000473:pathology*; D014057:Tomography, X-Ray Computed; D014474:Unconsciousness / Q000175:diagnosis* / Q000209:etiology