Mastronardi L, Puzzilli F, Ruggeri A, Guiducci A
Sandro Pertini Hospital, Division of Neurosurgery, Roma, Italy.
Clin Neurol Neurosurg. 1999 Jun;101(2):122-4. doi: 10.1016/s0303-8467(99)00017-7.
We report the case of a 73-year-old patient who presented a right motor deficit caused by an ipsilateral acute subdural hematoma. A magnetic resonance imaging (MRI) demonstration of Kernohan-Woltman notch phenomenon was obtained.
The woman sustained a major head injury at home, followed by loss of consciousness. On admission to the emergency room, she was comatose, anisochoric (left > right), and showed a reaction to pain with decerebrating movements of left limbs (Glasgow Coma Scale (GCS) 4/15). A right severe hemiparesis was observed. Cerebral computed tomography scan showed a large right hemispheric subdural hematoma. INTERVENTION AND POST-OPERATIVE COURSE: A wide right craniotomy was performed and the subdural hematoma evacuated. During the post-operative period, the level of consciousness gradually improved. A MRI performed about 2 weeks after operation showed a small area of abnormal signal intensity in the left cerebral peduncle. On discharge, the woman was able to communicate with others, but her right hemiparesis was still severe.
我们报告一例73岁患者，其因同侧急性硬膜下血肿出现右侧运动功能障碍。获得了磁共振成像（MRI）对克诺汉 - 沃尔特曼切迹现象的显示。
该女性在家中头部受重伤，随后失去意识。入院至急诊室时，她昏迷，瞳孔不等大（左侧>右侧），对疼痛有反应，左侧肢体出现去大脑强直运动（格拉斯哥昏迷量表（GCS）评分为4/15）。观察到右侧严重偏瘫。脑部计算机断层扫描显示右侧大脑半球有巨大硬膜下血肿。
进行了右侧大骨瓣开颅术并清除硬膜下血肿。术后期间，意识水平逐渐改善。术后约2周进行的MRI显示左侧大脑脚有一小片异常信号强度区域。出院时，该女性能够与他人交流，但右侧偏瘫仍很严重。
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