Laaidi Abdelkouddous, Hmada Saad, Naja Abdessamad, Lakhdar Abdelhakim
NEUROSURGERY Department, University Hospital Center IBN ROCHD, Casablanca, Morocco.
Ann Med Surg (Lond). 2022 Jun 14;79:104006. doi: 10.1016/j.amsu.2022.104006. eCollection 2022 Jul.
Kernohan Woltman Notch Phenomenon (KWNP) is caused by a supratentorial lesion pressing the contralateral cerebral peduncle against the free edge of the tentorium of the cerebellum. It is manifested by neurological signs of ipsilateral localization; cerebral MRI is the most sensitive examination for KWNP. Our patient is a 50-year-old woman, operated in 2011 for aortic and mitral valve replacement by mechanical prosthesis, under oral anticoagulant, consults for headaches evolving for 20 days without any notion of head trauma with installation of a progressively worsening left hemibody deficit. Glasgow coma scale was 14 (E3 V5 M6) with left anisocoria 4mm left/2mm right with left hemiplegia. CT shows a chronic left hemispheric subdural hematoma 13.5mm thick with subfalcorial and ipsilateral temporal involvement of the deficit. The cardiovascular examination as well as the biological assessment was unremarkable. The patient was operated on with a total recovery in 12 days, the anticoagulant is resumed on day 20 postoperatively, with close monitoring. KWNP may contribute to misdiagnosis in patients with bilateral corticospinal tract lesions, and anticoagulation poses a problem in stopping and restarting treatment due to the risk of bleeding on one side and thrombosis on the other side.
克诺汉-沃尔特曼切迹现象（KWNP）是由幕上病变将对侧大脑脚挤压至小脑幕游离缘所致。其表现为同侧定位的神经体征；脑部磁共振成像（MRI）是诊断KWNP最敏感的检查方法。我们的患者是一名50岁女性，2011年接受了主动脉瓣和二尖瓣机械瓣膜置换手术，术后口服抗凝剂，因头痛20天前来就诊，无头部外伤史，且逐渐出现左侧半身进行性加重的功能缺损。格拉斯哥昏迷量表评分为14分（E3 V5 M6），左侧瞳孔不等大，左侧4mm/右侧2mm，伴有左侧偏瘫。CT显示慢性左侧半球硬膜下血肿，厚度为13.5mm，伴有大脑镰下及同侧颞叶受累。心血管检查及实验室检查均无异常。患者接受手术治疗，12天后完全康复，术后第20天恢复抗凝治疗，并密切监测。KWNP可能导致双侧皮质脊髓束病变患者的误诊，并且由于存在一侧出血和另一侧血栓形成的风险，抗凝治疗在停药和重新用药方面存在问题。
