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Kernohan-Woltman notch phenomenon: a review article
C H Zhang1, R M DeSouza1, J S B Kho2
1a Department of Neurosurgery , Royal Sussex County Hospital , Brighton , United Kingdom.
British Journal of Neurosurgery
|October 27, 2016
Summary
The Kernohan-Woltman notch phenomenon (KWNP) can cause diagnostic confusion. Most patients with KWNP, often due to intracranial bleeds, show motor function improvement, with many achieving full recovery.
Area of Science:
- Neurology
- Neuroscience
- Clinical Medicine
Background:
- The Kernohan-Woltman notch phenomenon (KWNP) is a rare neurological sign.
- It is characterized by ipsilateral hemiparesis resulting from uncal herniation compressing the contralateral cerebral peduncle due to increased intracranial pressure.
- KWNP was first described in 1929 and is often associated with intracranial bleeds.
Observation:
- A literature review identified 39 cases of KWNP, predominantly caused by intracranial bleeds (36 cases, 22 traumatic).
- Other causes included arachnoid cysts, high-grade gliomas, and reabsorption bone syndrome.
- Associated clinical manifestations included third nerve palsy, mydriasis, facial nerve palsies, and parkinsonism.
Findings:
- Of the 39 patients, 26 (67%) experienced motor function improvement.
- Twelve patients (31%) achieved complete motor recovery or independence.
- The majority of cases were secondary to intracranial hemorrhages.
Implications:
- Understanding the clinical and pathophysiological characteristics of KWNP is crucial for accurate diagnosis.
- The findings suggest significant rehabilitation potential for patients with KWNP.
- Further research into the long-term outcomes of KWNP is needed to optimize patient rehabilitation strategies.
