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Kernohan-Woltman Notch Phenomenon Following Acute Subdural Hematoma.

Nathan Beucler1, Marie Monnier2, Anthony Faivre3

  • 1Neurosurgery Department, Sainte-Anne Military Teaching Hospital, Toulon, France; Ecole du Val-de-Grâce, French Military Health Service Academy, Paris, France.

World Neurosurgery
|October 28, 2023
PubMed
Summary

Kernohan-Woltman notch phenomenon, a rare complication of subdural hematoma, can cause paradoxical hemiparesis. Early diagnosis via MRI aids targeted neurological rehabilitation for motor deficits and hemineglect.

Keywords:
Acute subdural hematomaCraniotomyKernohan-Woltman

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Area of Science:

  • Neurology
  • Neurosurgery
  • Neuroimaging

Background:

  • Acute subdural hematoma can lead to severe neurological deficits, including coma.
  • Post-operative recovery from subdural hematoma may present with unexpected neurological signs.
  • Paradoxical neurological deficits require careful diagnostic evaluation.

Purpose of the Study:

  • To describe a case of Kernohan-Woltman notch phenomenon following acute subdural hematoma surgery.
  • To highlight the diagnostic utility of magnetic resonance imaging (MRI) in identifying this rare condition.
  • To emphasize the importance of accurate diagnosis for guiding neurological rehabilitation.

Main Methods:

  • Case report of a 72-year-old female patient.
  • Clinical assessment including Glasgow Coma Scale.
  • Brain magnetic resonance imaging (MRI) with diffusion-weighted imaging (DWI) and fluid-attenuated inversion recovery (FLAIR) sequences.

Main Results:

  • The patient developed left-sided hemiparesis despite a left-sided subdural hematoma.
  • MRI revealed a characteristic lesion in the right cerebral peduncle, consistent with Kernohan-Woltman notch phenomenon.
  • Glasgow Coma Scale score improved to 14, indicating partial neurological recovery.

Conclusions:

  • Kernohan-Woltman notch phenomenon is a crucial consideration in patients with subdural hematoma and paradoxical hemiparesis.
  • Advanced neuroimaging techniques like MRI are essential for diagnosing this specific neurological complication.
  • Accurate diagnosis facilitates tailored rehabilitation strategies addressing both motor deficits and hemineglect.