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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.

Keywords:

Kernohan corticospinal tract false localisation neurorehabilitation transtentorial herniation

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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.