ABSTRACT
El fenómeno de la escotadura de Kernohan-Woltman es una manifestación neurológica paradójica que consiste en un déficit motor ipsilateral a la lesión cerebral primaria. Este fenómeno es causado principalmente por hematomas subdurales agudos o crónicos postraumáticos, siendo los hematomas epidurales una causa menos frecuente. Este fenómeno debe ser tenido en cuenta en casos de déficit motor ipsilateral, ya que puede resultar en procedimientos quirúrgicos del lado equivocado. Presentamos el caso de un paciente de 40 años quien, tras sufrir un traumatismo craneoencefálico, presentó disminución del nivel de conciencia y anisocoria. La tomografía computarizada de cráneo evidenció un hematoma epidural parietofrontal derecho con desplazamiento de la línea media y herniación uncal. Se realizó craneotomía y drenaje del hematoma y al sexto día del postoperatorio se evidenció una hemiparesia braquiocrural derecha. En la resonancia magnética se observó un área de isquemia capsulopeduncular izquierda acorde con el diagnóstico de fenómeno de la escotadura de Kernohan-Woltman (AU)
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
Subject(s)
Humans , Male , Adult , Hematoma, Epidural, Cranial/surgery , Craniocerebral Trauma/complications , Paresis/etiology , Anisocoria/etiology , Consciousness Disorders/etiology , Craniotomy , Drainage , Postoperative Complications , Diagnostic Errors/prevention & controlABSTRACT
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.
