Kernohan-Woltman notch phenomenon: an exceptional neurological picture?

Autor:	Carrasco Moro R; Servicio de Neurocirugía, Hospital Universitario Ramón y Cajal, Madrid, Spain. Electronic address: rodrigo.carrasco@salud.madrid.org., Pascual Garvi JM; Servicio de Neurocirugía, Hospital Universitario La Princesa, Madrid, Spain., Vior Fernández C; Servicio de Neurocirugía, Hospital Universitario Ramón y Cajal, Madrid, Spain., Espinosa Rodríguez EE; Servicio de Neurocirugía, Instituto de Medicina y Cirugía Barcelona, Barcelona, Spain., Martín Palomeque G; Servicio de Neurofisiología Clínica, Hospital Universitario Ramón y Cajal, Madrid, Spain., Cabañes Martínez L; Servicio de Neurofisiología Clínica, Hospital Universitario Ramón y Cajal, Madrid, Spain., López Gutiérrez M; Servicio de Neurocirugía, Hospital Central de la Defensa Gómez Ulla, Madrid, Spain., Acitores Cancela A; Servicio de Neurocirugía, Hospital Universitario Ramón y Cajal, Madrid, Spain., Barrero Ruiz E; Servicio de Neurocirugía, Hospital Universitario Ramón y Cajal, Madrid, Spain., Martínez San Millán JS; Servicio de Diagnóstico por Imagen, Hospital Universitario Ramón y Cajal, Madrid, Spain.
Jazyk:	angličtina
Zdroj:	Neurologia [Neurologia (Engl Ed)] 2024 Oct; Vol. 39 (8), pp. 683-693. Date of Electronic Publication: 2022 Nov 14.
DOI:	10.1016/j.nrleng.2022.09.010
Abstrakt:	Introduction: Ipsilateral hemiparesis (IH) can be defined as a paradoxical dysfunction of the first motor neuron involving the extremities on the opposite side to that expected, given the location of the triggering intracranial pathology. Compression of the corticospinal tract (CSt) along its course through the contralateral cerebral peduncle against the free edge of the tentorium, known as the Kernohan-Woltman notch phenomenon (KWNP), represents the main cause of IH. Methods: This retrospective study analyses a series of 12 patients diagnosed with IH secondary to KWNP treated at our institution, including a descriptive study of epidemiological, clinical, radiological, neurophysiological, and prognostic variables. Results: In 75% of the cases, symptoms had an acute or subacute onset. Initial imaging studies showed signs of significant mass effect in half of the patients, whereas magnetic resonance imaging (MRI) identified a structural lesion in the contralateral cerebral peduncle in two thirds of them. Impairment of the motor evoked potentials (MEP) was verified in 4 patients. During follow-up 7 patients experienced improvement in motor activity, and near half of the cases were classified in the first three categories of the modified Rankin scale. Conclusions: In contrast to prior historical series, most of our patients developed a KWNP secondary to a traumatic mechanism. MRI represents the optimal method to identify both the classic cerebral peduncle notch and the underlying structural lesion of the CSt. The use of MEP can help to establish the diagnosis, especially in those cases lacking definite radiological findings. (Copyright © 2022 Sociedad Española de Neurología. Published by Elsevier España, S.L.U. All rights reserved.)
Databáze:	MEDLINE
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