Kernohan-Woltman notch phenomenon caused by an acute subdural hematoma

J Clin Neurosci. 2009 Dec;16(12):1628-31. doi: 10.1016/j.jocn.2009.02.015. Epub 2009 Sep 17.

Abstract

Uncal herniation through the tentorial notch is occasionally associated with false localizing ipsilateral hemiparesis, known as the Kernohan-Woltman notch phenomenon (KWNP). We report an 81-year-old female who presented with a decreased level of consciousness, a right mydriasis and an ipsilateral motor deficit caused by a large right hemispheric subdural hematoma that was immediately evacuated. The patient recovered well, although her right hemiplegia persisted. A follow-up MRI showed a residual lesion in the left cerebral peduncle, corresponding to KWNP. The presence of such a structural lesion suggests a poor prognosis for recovery from the initial motor deficit.

Publication types

  • Case Reports

MeSH terms

  • Aged, 80 and over
  • Female
  • Functional Laterality / physiology*
  • Hematoma, Subdural, Acute / complications*
  • Humans
  • Magnetic Resonance Imaging / methods
  • Tegmentum Mesencephali / pathology*
  • Tomography, X-Ray Computed / methods