Zafonte R D, Lee C Y
Department of Physical Medicine and Rehabilitation, Detroit Medical Center, Wayne State University School of Medicine, MI, USA.
Arch Phys Med Rehabil. 1997 May;78(5):543-5. doi: 10.1016/s0003-9993(97)90174-x.
Posttraumatic ipsilateral motor deficits are rare and raise etiologic and prognostic concerns for the rehabilitation team. We present two cases with an unusual central neurologic cause of ipsilateral weakness. The first patient was assaulted, with a resultant severe traumatic brain injury. Initial computed tomography showed a large right subdural hematoma (SDH) with significant mass effect. Following a craniotomy for evacuation of the SDH, the patient was noted to have paradoxical right-sided (ipsilateral) motor deficits. Postoperative magnetic resonance imaging (MRI) showed compression of the contralateral (left) cerebral peduncle against the tentorium, thus resulting in ipsilateral (right-sided) motor weakness (the Kernohan-Woltman notch phenomenon). Prior limited reports carried a grave prognosis for these patients. On discharge from inpatient rehabilitation, the patient was functioning at a Rancho Los Amigos Scale VI. The second patient was involved in a motor vehicle accident and was found to have a large left frontotemporal subdural hematoma with shift. A dense left hemiplegia was noted after hematoma evacuation. MRI also showed a right cerebral peduncle hypointensity. At discharge, the patient was rated a Rancho Los Amigos Scale VI. Physiatrists need to be aware of the causes of ipsilateral motor weakness as well as the limitations of prognostic data.
创伤后同侧运动功能缺损较为罕见，这给康复团队带来了病因及预后方面的担忧。我们报告两例因特殊中枢神经病因导致同侧肌无力的病例。首例患者遭人袭击，导致严重创伤性脑损伤。最初的计算机断层扫描显示右侧有巨大硬膜下血肿（SDH），伴有明显的占位效应。在进行开颅手术清除SDH后，发现患者出现反常的右侧（同侧）运动功能缺损。术后磁共振成像（MRI）显示对侧（左侧）大脑脚被挤压至小脑幕，从而导致同侧（右侧）运动无力（克诺汉-沃尔特曼切迹现象）。此前有限的报告显示这些患者预后不佳。从住院康复出院时，该患者的功能状态为兰乔斯·阿米戈斯量表VI级。第二例患者遭遇机动车事故，发现有巨大的左侧额颞部硬膜下血肿并伴有脑移位。血肿清除后出现严重的左侧偏瘫。MRI还显示右侧大脑脚信号减低。出院时，该患者的兰乔斯·阿米戈斯量表评分为VI级。物理治疗师需要了解同侧运动无力的病因以及预后数据的局限性。
