False localizing signs in traumatic brain injury
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Updated: Jun 22, 2026
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Published on: January 30, 2018
Cristin McKenna1, Jonathan Fellus, Anna M Barrett
1Kessler Institute for Rehabilitation, West Orange, NJ 07052, USA. cmckenna@kmrrec.org
Background:
Hemiparesis ipsilateral to a mass-occupying lesion can be due to Kernohan-Woltman Notch Phenomenon (KWNP). This syndrome implies a false-localizing sign because clinical findings lead the examiner to an incorrect neuroanatomical diagnosis. The contralateral crus cerebri (pyramidal tract) is pressed against the tentorial incisum and a resultant hemiparesis is found on the same side of the lesion.
Review:
A detailed literature search of false-localizing signs is presented.
Conclusions:
Not infrequently, patients presenting to a physiatrist may have incomplete records. The existence of false localizing signs may point the physician towards the wrong underlying pathology.
