The First Case of Kernohan-Woltman Notch Phenomenon Caused by Epidural Hematoma in a Pediatric Patient

Öztürk, Sait; Ozturk, Yasar; Ocal, Ozgur

doi:10.1159/000474945

Cited by 4 publications

(3 citation statements)

References 15 publications

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“…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%

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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Section: Database Researchmentioning

confidence: 99%

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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“…6 For HICH patients with supratentorial hematoma volume ≥ 20mL or infratentorial hematoma volume ≥ 10 mL, surgery is still the primary choice. 7 With the development of neuroendoscopy, the application of brain microsurgery is becoming increasingly mature, and most intracranial space-occupying lesions can be removed by microsurgery. 8 Stereotactic technology was firstly reported to be used in the treatment of HICH in 1978, with the Patients with Hypertensive Intracerebral Hemorrhage…”

Section: Discussionmentioning

confidence: 99%

A comparative study on the efficacy of robot of stereotactic assistant and frame-assisted stereotactic drilling, drainage for intracerebral hematoma in patients with hypertensive intracerebral hemorrhage

Liang

Li²,

Dong³

et al. 2022

Pak J Med Sci

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Objectives: To compare the clinical efficacy of robot of stereotactic assistant (ROSA) and frame-assisted stereotactic drilling and drainage for intracerebral hematoma in hypertensive intracerebral hemorrhage (HICH). Methods: A total of 142 patients with HICH treated in Baoding First Central Hospital from January 2018 to January 2020 were selected and divided into two groups using a random number table. The ROSA group was treated with a robot of stereotactic assistant, while the frame group underwent frame-assisted stereotactic drilling and drainage for intracerebral hematoma. Surgical duration, postoperative extubation time and complications were compared between the two groups. Venous blood (5 mL) was collected before and three days after surgery. The levels of inflammatory factors [tumor necrosis factor-α (TNF-α), high-sensitivity C-reactive protein (hs-CRP) and interleukin-6 (IL-6)], as well as neurological function indexes [neuron-specific enolase (NSE), nerve growth factor (NGF) and brain-derived neurotrophic factor (BDNF)] were detected by enzyme-linked immunosorbent assay. Results: The surgical duration, postoperative extubation time, and incidences of infection and postoperative rehemorrhage in the ROSA group were lower than those in the frame group (P < 0.05). In the ROSA group, postoperative TNF-α, hs-CRP, IL-6 and NSE levels were significantly lower while NGF and BDNF levels were higher than those in the frame group (all P < 0.05). Conclusion: Compared with frame-assisted stereotactic drilling and drainage for intracerebral hematoma, ROSA in HICH treatment shortens the surgical duration and postoperative extubation time, reduces the risks of infection and rehemorrhage and decreases inflammatory level, which is helpful for the recovery of neurological function. doi: https://doi.org/10.12669/pjms.38.7.5481 How to cite this:Liang L, Li X, Dong H, Gong X, Wang G. A comparative study on the efficacy of robot of stereotactic assistant and frame-assisted stereotactic drilling, drainage for intracerebral hematoma in patients with hypertensive intracerebral hemorrhage. Pak J Med Sci. 2022;38(7):---------. doi: https://doi.org/10.12669/pjms.38.7.5481 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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“…1,7 A few studies have reported the association of the Kernohan-Woltman notch phenomenon with epidural hematoma. 8 Evaluation with brain CT would be sufficient in most patients with a severe traumatic head injury, and the decision for surgical intervention is usually made on the basis of the neurological condition of the patient and brain CT result. Most MRI studies are performed after the surgical intervention.…”

Section: Discussionmentioning

confidence: 99%

Kernohan-Woltman Notch Phenomenon Caused by a Traumatic Epidural Hematoma

Lee¹,

Kang²,

Kim³

et al. 2019

J Neurosonol Neuroimag

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Journal of Neurosonology and Neuroimaging was deeply drowsy and had frequent absence seizure attacks during the ED admission. On neurological examination, she had no muscle weakness, and her pupils were equal in size and constricted equally in response to light stimulus. Owing to her drowsy mental state, the extraocular movement could not be adequately checked, but no eyeball deviation was observed. Brain CT revealed an acute right temporoparietal epidural hematoma with a midline shift (Fig. 1A, B). She underwent an urgent decompressive craniotomy and hematoma removal. She was admitted to the intensive care unit, where she received supportive care. As her mental state improved, we noticed right-limb weakness (grade

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The First Case of Kernohan-Woltman Notch Phenomenon Caused by Epidural Hematoma in a Pediatric Patient

Cited by 4 publications

References 15 publications

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

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

A comparative study on the efficacy of robot of stereotactic assistant and frame-assisted stereotactic drilling, drainage for intracerebral hematoma in patients with hypertensive intracerebral hemorrhage

Kernohan-Woltman Notch Phenomenon Caused by a Traumatic Epidural Hematoma

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