Department of Neurology and Stroke Medicine, Tokyo Metropolitan Tama Medical Center, Japan.
Department of Neurosurgery, Tokyo Metropolitan Tama Medical Center, Japan.
Intern Med. 2021 Jan 15;60(2):309-313. doi: 10.2169/internalmedicine.5621-20. Epub 2020 Sep 19.
A 24-year-old female patient was admitted for a right frontal intracranial hematoma with an uncal herniation due to a ruptured arteriovenous malformation and therefore underwent emergency surgery. Neuroimaging revealed left-sided midbrain notching against the tentorium, indicating Kernohan's notch phenomenon. She denied experiencing any short-term neurological deficits but right-sided delayed hemiparkinsonism developed 18 months later. Dopamine transporter tracer uptake was severely reduced in the left striatum, suggesting nigrostriatal degeneration secondary to Kernohan's notch. Uncal herniations are potentially fatal, but surgery can save the patient's life and improve the functional outcomes. Clinicians should therefore be aware of delayed hemiparkinsonism as a rare complication of Kernohan's notch phenomenon.
一位 24 岁女性患者因动静脉畸形破裂导致右侧额部颅内血肿伴小脑幕切迹疝入院，因此接受了紧急手术。神经影像学显示，左中脑对天幕形成切迹，提示 Kernohan 切迹现象。她否认出现任何短期神经功能缺损，但 18 个月后出现右侧迟发性偏瘫帕金森综合征。多巴胺转运体示踪剂摄取在左侧纹状体严重减少，提示 Kernohan 切迹引起的黑质纹状体变性。小脑幕切迹疝有潜在致命性，但手术可以挽救患者生命并改善功能结局。因此，临床医生应意识到 Kernohan 切迹现象的一种罕见并发症——迟发性偏瘫帕金森综合征。
