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Updated: Apr 12, 2026
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Comprehensive Endovascular and Open Surgical Management of Cerebral Arteriovenous Malformations
Published on: October 20, 2017
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Ruptured Arteriovenous Malformation Presenting with Kernohan's Notch
Christopher F Dibble1, Michael P Wemhoff2, Tarik Ibrahim2
1Department of Neurological Surgery, University of North Carolina School of Medicine, Chapel Hill, NC 27514, USA.
Case Reports in Neurological Medicine
|May 23, 2015
Summary
Arteriovenous malformations (AVMs) can cause intracranial hemorrhage. This case highlights a rare instance where an AVM hemorrhage led to ipsilateral neurological deficits via Kernohan's Notch phenomenon, identifiable by MRI.
Area of Science:
- Neurology
- Neurosurgery
- Radiology
Background:
- Arteriovenous malformations (AVMs) are congenital vascular lesions.
- AVMs predispose individuals to intracranial hemorrhage (ICH) and neurological deficits.
- Deficits are typically focal and contralateral to the hemorrhage site.
Purpose of the Study:
- To present a rare case of ipsilateral neurological deficits.
- To illustrate Kernohan's Notch phenomenon resulting from AVM hemorrhage.
- To emphasize the diagnostic role of MRI in such cases.
Main Methods:
- Case report of a 31-year-old woman with a left parietal AVM.
- Initial presentation with seizures, followed by obtundation after 4 years.
- Diagnosis confirmed via MRI and angiographic imaging, including identification of Kernohan's Notch.
Main Results:
- Acute left parietal ICH and subdural hematoma (SDH) with mass effect.
- Post-operative ipsilateral hemiplegia with contralateral command following.
- MRI confirmed right Kernohan's Notch phenomenon.
- Significant neurological improvement after rehabilitation and treatment.
Conclusions:
- Kernohan's Notch phenomenon is a rare complication of AVM hemorrhage.
- This false localizing sign presents with paradoxical motor impairment.
- MRI is crucial for identifying Kernohan's Notch in AVM-related hemorrhages.
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