Beucler Nathan, Cungi Pierre-Julien, Baucher Guillaume, Coze Stéphanie, Dagain Arnaud, Roche Pierre-Hugues
Department of Neurosurgery, Sainte-Anne Military Teaching Hospital, Toulon, France.
Ecole du Val-de-Grâce, French Military Health Service Academy, Paris, France.
J Korean Neurosurg Soc. 2022 Sep;65(5):652-664. doi: 10.3340/jkns.2022.0002. Epub 2022 May 16.
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.
克诺汉 - 沃尔特曼切迹现象（KWNP）是指颅内病变引起巨大的双侧占位效应，导致对侧大脑脚被挤压至小脑幕游离缘。诊断依据是病变同侧出现“矛盾性”运动功能缺损，同时伴有对侧大脑脚损伤的影像学证据。迄今为止，关于KWNP相关的神经影像学模式和运动功能预后因素的证据稀少。按照系统评价与Meta分析的首选报告项目（PRISMA）指南，对Medline数据库从建库至2021年7月进行了系统评价，以查找有关KWNP的英文文章。该研究共纳入45篇文章，涉及51例患者。患者平均年龄为40.7岁，男女比例为2∶1。63%的患者（32/51）有头部外伤史，其中大多数为急性硬膜下血肿（57%，29/51）。57%（29/51）的患者入院时处于昏迷状态，47%（24/51）存在瞳孔异常。KWNP的神经影像学特征为对侧大脑脚出现压迫性缺血性卒中，周围结构有水肿，有时附近的脑动脉也会出现压迫性卒中。45%的患者（23/51）运动功能预后良好；然而，未发现相关的易感因素。格拉斯哥昏迷量表（GCS）评分大于3显示出运动功能预后较好的趋势（p = 0.1065）。KWNP为一种局部压迫综合征，常由突然发生的巨大钩回疝引起，导致对侧大脑脚缺血。尽管KWNP患者通常总体恢复良好，但GCS评分为3分的患者运动功能预后可能较差。为了更好地理解该综合征，未来的研究需聚焦于更具个性化的标准，如小脑幕切迹宽度的个体差异。
