Neuro-images Kernohan–Woltman notch phenomenon in acute subdural hematoma

Harmsen, Bibet L Ten; Kleermaeker, Floriaan G. C. M. De; Leeuw, Carola de; Dijk, G. van

doi:10.1007/s13760-019-01270-9

Cited by 2 publications

(5 citation statements)

References 4 publications

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“…Reports concerning patients suffering from KWNP ranged from 1990 to 2020 [ 2 - 10 , 13 - 15 , 17 , 19 - 21 , 23 , 26 - 30 , 33 - 37 , 39 - 41 , 43 - 46 , 49 , 50 , 52 - 55 , 59 - 63 ]. The database research yielded 220 articles and 149 after removal of duplicates.…”

Section: Resultsmentioning

confidence: 99%

“…Among them, the cerebral peduncle contralateral to the lesion was pathological in 44 patients (86%) and normal in three patients (6%). In a subacute setting, the lesion in the cerebral peduncle presented hypointense signal in T1-weighted sequence [ 28 , 36 , 40 , 41 , 50 , 62 ] and hyperintense signal in T2-weighted sequ ence [ 2 , 3 , 5 , 10 , 13 , 20 , 21 , 23 , 28 , 33 , 34 , 36 , 37 , 39 - 41 , 46 , 50 , 52 - 55 , 61 , 63 ] and in fluid-attenuated inversion recovery (FLAIR) sequence [ 2 , 4 , 14 , 19 - 21 , 34 , 37 , 60 ]. It displayed restricted diffusion with brightness in diffusion-weighted imaging (DWI) [ 7 , 9 , 14 , 21 , 34 , 39 , 52 - 54 ], and apparent diffusion coefficient low values [ 9 , 54 ].…”

Section: Resultsmentioning

confidence: 99%

“…In a subacute setting, the lesion in the cerebral peduncle presented hypointense signal in T1-weighted sequence [ 28 , 36 , 40 , 41 , 50 , 62 ] and hyperintense signal in T2-weighted sequ ence [ 2 , 3 , 5 , 10 , 13 , 20 , 21 , 23 , 28 , 33 , 34 , 36 , 37 , 39 - 41 , 46 , 50 , 52 - 55 , 61 , 63 ] and in fluid-attenuated inversion recovery (FLAIR) sequence [ 2 , 4 , 14 , 19 - 21 , 34 , 37 , 60 ]. It displayed restricted diffusion with brightness in diffusion-weighted imaging (DWI) [ 7 , 9 , 14 , 21 , 34 , 39 , 52 - 54 ], and apparent diffusion coefficient low values [ 9 , 54 ]. Last, it presented hypointense signal in gradient echo sequence [ 5 ] and evidence of blood-brain barrier rupture in post-contrast T1-weighted imaging [ 21 ].…”

Section: Resultsmentioning

confidence: 99%

“…Reports concerning patients suffering from KWNP ranged from 1990 to 2020 [2][3][4][5][6][7][8][9][10][13][14][15]17,[19][20][21]23,[26][27][28][29][30][33][34][35][36][37][39][40][41][43][44][45][46]49,50,[52][53][54][55][59][60][61][62][63] . The database research yielded 220 articles and 149 after removal of duplicates.…”

Section: Database Researchmentioning

confidence: 99%

“…In a subacute setting, the lesion in the cerebral peduncle presented hypointense signal in T1-weighted sequence 28,36,40,41,50,62) and hyperintense signal in T2-weighted sequ ence 2,3,5,10,13,20,21,23,28,33,34,36,37,[39][40][41]46,50,[52][53][54][55]61,63) and in fluid-attenuated inversion recovery (FLAIR) sequence 2,4,14,[19][20][21]34,37,60) . It displayed restricted diffusion with brightness in diffusion-weighted imaging (DWI) 7,9,14,21,34,39,[52][53][54] , and apparent diffusion coefficient low values 9,…”

Section: Diagnostic Mrimentioning

confidence: 99%

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The Kernohan-Woltman Notch Phenomenon : A Systematic Review of Clinical and Radiologic Presentation, Surgical Management, and Functional Prognosis

Beucler

Cungi

Baucher

et al. 2022

J Korean Neurosurg Soc

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The Kernohan-Woltman notch phenomenon (KWNP) refers to an intracranial lesion causing massive side-to-side mass effect which leads to compression of the contralateral cerebral peduncle against the free edge of the cerebellar tentorium. Diagnosis is based on “paradoxical” motor deficit ipsilateral to the lesion associated with radiologic evidence of damage to the contralateral cerebral peduncle. To date, there is scarce evidence regarding KWNP associated neuroimaging patterns and motor function prognostic factors. A systematic review was conducted on Medline database from inception to July 2021 looking for English-language articles concerning KWNP, in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The research yielded 45 articles for a total of 51 patients. The mean age was 40.7 years-old and the male/female sex ratio was 2/1. 63% of the patients (32/51) suffered from head trauma with a majority of acute subdural hematomas (57%, 29/51). 57% (29/51) of the patients were in the coma upon admission and 47% (24/51) presented pupil anomalies. KWNP presented the neuroimaging features of compression ischemic stroke located in the contralateral cerebral peduncle, with edema in the surrounding structures and sometimes compression stroke of the cerebral arteries passing nearby. 45% of the patients (23/51) presented a good motor functional outcome; nevertheless, no predisposing factor was identified. A Glasgow coma scale (GCS) of more than 3 showed a trend (p=0.1065) toward a better motor functional outcome. The KWNP is a regional compression syndrome oftentimes caused by sudden and massive uncal herniation and leading to contralateral cerebral peduncle ischemia. Even though patients suffering from KWNP usually present a good overall recovery, patients with a GCS of 3 may present a worse motor functional outcome. In order to better understand this syndrome, future studies will have to focus on more personalized criteria such as individual variation of tentorial notch width.

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