Mejía Kattah J, Vilá Barriuso E, García Bernedo C, Gallart Gallego L
Servicio de Anestesiología, Reanimación y Terapéutica del Dolor, Parc de Salut Mar, Institut Hospital del Mar d'Investigacions Mèdiques (INIM), Universitat Autònoma de Barcelona, Barcelona, España.
Servicio de Anestesiología, Reanimación y Terapéutica del Dolor, Parc de Salut Mar, Institut Hospital del Mar d'Investigacions Mèdiques (INIM), Universitat Autònoma de Barcelona, Barcelona, España.
Rev Esp Anestesiol Reanim. 2014 Jun-Jul;61(6):332-5. doi: 10.1016/j.redar.2013.05.003. Epub 2013 Jul 1.
Kernohan-Woltman notch phenomenon is a paradoxical neurological manifestation which involves a motor deficit on the same side as the primary brain injury. It is produced mainly by acute or chronic subdural hematomas, and less frequently by post-traumatic epidural ones. It should be taken into consideration in cases of ipsilateral motor deficit, as it may lead to surgical procedures being performed on the incorrect side. We report the case of a 40 year old man who sustained a major head injury which was followed by a decreased level of consciousness and anisocoria. Computed tomography of the brain revealed a frontal and parietal epidural hematoma with right midline shift and uncal herniation. Craniotomy and drainage of the hematoma was performed, and on the sixth day after surgery it was observed that the patient had a brachio-crural right hemiparesis. Magnetic resonance imaging showed an ischemic area on the left capsule and cerebral peduncle consistent with the diagnosis of Kernohan-Woltman notch phenomenon.
克诺汉-沃尔特曼切迹现象是一种矛盾的神经学表现，其特征为运动功能缺损出现在原发性脑损伤的同侧。它主要由急性或慢性硬膜下血肿引起，较少由创伤后硬膜外血肿导致。对于同侧运动功能缺损的病例应考虑到这一现象，因为它可能导致在错误的一侧进行手术操作。我们报告一例40岁男性，他遭受严重头部损伤，随后出现意识水平下降和瞳孔不等大。脑部计算机断层扫描显示额部和顶部硬膜外血肿伴右侧中线移位和钩回疝。进行了开颅血肿引流术，术后第六天观察到患者出现右侧臂-腿偏瘫。磁共振成像显示左侧囊和大脑脚有缺血区域，符合克诺汉-沃尔特曼切迹现象的诊断。
