Kernohan-Woltman notch phenomenon: an exceptional neurological picture?

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Abstract

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.
克诺汉-沃尔特曼缺口现象:一种特殊的神经症状?
导言:同侧偏瘫(IH)可定义为第一运动神经元的矛盾性功能障碍,根据颅内病变的诱发位置,该功能障碍累及与预期相反的一侧肢体。皮质脊髓束(CSt)在穿过对侧大脑脚的过程中受到触角游离缘的压迫,即克尔诺汉-沃尔特曼切迹现象(KWNP),是导致 IH 的主要原因:这项回顾性研究分析了在我院接受治疗的 12 例继发于 KWNP 的 IH 患者,包括对流行病学、临床、放射学、神经生理学和预后变量的描述性研究:在75%的病例中,症状均为急性或亚急性起病。最初的影像学检查显示,半数患者有明显的肿块效应,而磁共振成像(MRI)则发现其中三分之二的患者对侧大脑脚有结构性病变。经证实,4 名患者的运动诱发电位(MEP)受损。随访期间,7 名患者的运动活动有所改善,近半数病例被归入改良兰金量表的前三类:结论:与之前的历史研究相比,我们的大多数患者都是继发于创伤机制的 KWNP。磁共振成像是鉴别典型的脑干切迹和CSt潜在结构性病变的最佳方法。 MEP的使用有助于确诊,尤其是在缺乏明确放射学检查结果的病例中。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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