Reversible Kernohan notch

Oster, Joel; Jones, H. Royden; Hildenbrand, P.; Tronic, Bruce S.; Cosgrove, G. Rees

doi:10.1212/01.wnl.0000248190.45078.e6

Cited by 9 publications

(5 citation statements)

References 27 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Last, it presented hypointense signal in gradient echo sequence [ 5 ] and evidence of blood-brain barrier rupture in post-contrast T1-weighted imaging [ 21 ]. Middle-term and long-term aspect displayed hypointense signal in T1-weighted sequence [ 27 ], and hyperintense signal in T2-weighted [ 8 , 15 , 27 , 44 ] and FLAIR imaging [ 44 ].…”

Section: Resultsmentioning

confidence: 99%

“…The medium-term and long-term aspect of the midbrain lesion associated with KWNP displayed the neuroimaging features of “white matter hyperintensity (WMH)” [ 18 ] which corresponds to hyperintensity in T2 [ 8 , 15 , 27 , 44 ] and FLAIR sequence [ 44 ] after ischemic stroke. Hypointensity in T1-weighted imaging indicated cerebral atrophy [ 27 ].…”

Section: Discussionmentioning

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%

See 2 more Smart Citations

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

View full text Add to dashboard Cite

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.

show abstract

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

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

View full text Add to dashboard Cite

show abstract

“…Although FTLD phenotypes such as these share some clinical features with Alzheimer's disease (AD), research suggests that other behavioral and cognitive characteristics distinguish FTLD phenotypes from each other and from AD. 6,7 Previous neuropsychological studies 6,8 have focused on the cross-sectional distinctions between FTLD and AD and this research has augmented our understanding of the pathology and diagnoses of these dementia syndromes. By contrast, there has been much less research comparing and contrasting the longitudinal decline in AD and FTLD.…”

Section: Introductionmentioning

confidence: 99%

Differential Longitudinal Decline on the Mini-Mental State Examination in Frontotemporal Lobar Degeneration and Alzheimer Disease

Tan

Libon

Rascovsky

et al. 2013

Alzheimer Disease &Amp; Associated Disorders

View full text Add to dashboard Cite

Objective To examine how phenotype affects longitudinal decline on the Mini-Mental State Examination (MMSE) in patients with frontotemporal lobar degeneration (FTLD) and Alzheimer's disease (AD) Background The MMSE is the most commonly administered assessment for dementia severity; however, the effects of phenotype on longitudinal MMSE performance in FTLD and AD have not been extensively studied. Methods Data from 185 patients diagnosed with AD (n=106) and three FTLD (n=79) phenotypes (behavioral variant frontotemporal dementia [bvFTD], nonfluent agrammatic variant of primary progressive aphasia [nfaPPA], and semantic variant PPA [svPPA]) were collected for up to 52 months since initial evaluation. Results Differential rates of decline were noted in that MMSE scores declined more precipitously for AD and svPPA compared to bvFTD and nfaPPA patients (p=0.001). The absolute 4-year MMSE decline given median baseline MMSE for bvFTD (14.67, 95% confidence interval [CI]: 14.63-14.71) and nfaPPA (11.02, 95% CI: 10.98-11.06) were lower than svPPA (22.32, 95% CI: 22.29-22.34) or AD (22.24, 95% CI: 22.22-22.26). Conclusions These data suggest that within-group AD and FTLD phenotypes present distinct patterns of longitudinal decline on the MMSE. MMSE may not be adequately sensitive to track disease progression in some phenotypes of FTLD.

show abstract

“…Signal changes were seen even when MRI was performed 9 months after injury [ 14 ]. Oster et al [ 15 ] reported that the T2 hyperintense lesion on a KWNP patient can resolve with rehabilitation. Moon et al [ 16 ] described that a lack of MRI signal change may correlate with a better functional prognosis.…”

Section: Discussionmentioning

confidence: 99%

A case of Kernohan-Woltman notch phenomenon caused by an epidural hematoma: the diagnostic and prognostic value of PET/CT imaging

et al. 2022

View full text Add to dashboard Cite

Background Kernohan-Woltman notch phenomenon (KWNP) classically occurs when a lesion causes compression of the contralateral cerebral peduncle against the tentorium, resulting in ipsilateral hemiparesis. It has been studied clinically, radiologically and electrophysiologically which all confirmed to cause false localizing motor signs. Here, we demonstrate the potential use of fluorine-18 fluorodeoxyglucose (18 F-FDG) positron emission tomography/computed tomography (PET/CT) to identify KWNP caused by an epidural hematoma. Case presentation A 29-year-old male patient post right-sided traumatic brain injury presenting with persistent ipsilateral hemiparesis. Patient underwent decompressive craniotomy and intracranial hematoma evacuation. Brain magnetic resonance imaging in the postoperative period showed a subtle lesion in the left cerebral peduncle. PET/CT was performed to exclude early brain tumor and explain his ipsilateral hemiparesis. PET/CT imaging demonstrated a focal region of intense 18 F-FDG uptake in the left cerebral peduncle. Throughout the treatment in outpatient neurorehabilitation unit, the patient exhibited a gradual recovery of his right hemiparesis. Conclusion In our case report, for the first time, PET/CT offered microstructural and functional confirmation of KWNP. Moreover, our case suggests that 18 F-FDG PET/CT may serve as an important reference for the probability of functional recovery.

show abstract

Reversible Kernohan notch

Cited by 9 publications

References 27 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

Differential Longitudinal Decline on the Mini-Mental State Examination in Frontotemporal Lobar Degeneration and Alzheimer Disease

A case of Kernohan-Woltman notch phenomenon caused by an epidural hematoma: the diagnostic and prognostic value of PET/CT imaging

Contact Info

Product

Resources

About