Kernohan-Woltman Notch Phenomenon Related to Chronic Subdural Hematoma: A Case Report

Abstract

Kernohan-Woltman notch phenomenon defines the neurological picture caused by a compressive injury of the cerebral peduncles at the tentorial edge due to the contralateral supratentorial lesion and leads to ipsilateral hemiparesis or hemiplegia and mydriasis. We have represented this case of Kernohan-Woltman notch phenomenon that developed secondary to chronic subdural hematoma in a 88-year-old patient as a very rarely reported case. We conclude that advanced brain atrophy contributes to the formation of Kernohan-Woltman notch phenomenon resulted from chronic subdural hematoma. Additionally, investigation of cerebral peduncles via magnetic resonance imaging is important in determination of the clinical picture and evaluation of the response to the treatment in such cases. Figure 1. Brain CT showing CSH at right frontoparietal and an evident shift to left side of brain.

Kernohan's notch syndrome in acute subdural hematoma: significance of coronal views of computed tomography scan imaging for emergent preoperative diagnosis

“…4,7 Several study by Kernohan and Woltman in 1929 described that any supratentorial mass may produce a significant compression to the contralateral cerebral peduncles where anatomically is adjacent to the tentorial edge. 1 It has also been reported that the compression that caused injury of corticospinal tracts in the contralateral cerebral peduncles may cause the ipsilateral weakness, in the course of Kernohan's notch syndrome. 2 However, there is no comprehensive clinical trial which elaborate the incidence of Kernohan's notch syndrome.…”

“…It was in 1929, Kernohan and Woltman first demonstrated compression of the cerebral peduncle against the free edge of the tentorium. [1][2][3] They studied the gross and microscopic appearance of 276 brains with tumor and showed 34 (12%) with various "degrees of notching" of the cerebral peduncle. 3 Also, they reported a case of patient with left supratentorial brain tumor with left hemiparesis.…”

“…This phenomenon is usually reported secondary to advance-stage brain neoplasma or severe brain injury. 1 This syndrome describe initially by Kernohan and Woltman in 1929, they reported a case of ipsilateral hemiplegia accompanying expanding supratentorial brain tumor. 2,6 They demonstrated grooving of the cerebral peduncle on the side opposite to brain lesion.…”

“…Kernohan's notch syndrome is defined as compression of the cerebral peduncle by the tentorial edge. 1 This may due to a contralateral supratentorial mass, which produces ipsilateral hemiparesis or hemiplegia. This phenomenon is usually reported secondary to advance-stage brain neoplasma or severe brain injury.…”

“…4 For such cases the computed tomography imaging with emphasized on coronal images study will be the important tools to definitively diagnose the Kernohan's notch syndrome as complication of an expanding supratentorial mass lesion. 1,5…”