Images in Intensive Medicine
Kernohan–Woltman notch phenomenon: Beware of the wrong side!
Fenómeno de Kernohan-Woltman: ¡cuidado con el lado equivocado!
L.P. Maskin
, A. Hlavnicka, N. Wainsztein
Corresponding author
Intensive Care Unit, Raúl Carrea Neurological Research Institute, FLENI, Buenos Aires, Argentina
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Red arrows indicate locations of high-density shadows.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "J. Song, S.J. Gong, Y.H. Yu" "autores" => array:3 [ 0 => array:2 [ "nombre" => "J." "apellidos" => "Song" ] 1 => array:2 [ "nombre" => "S.J." "apellidos" => "Gong" ] 2 => array:2 [ "nombre" => "Y.H." "apellidos" => "Yu" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173572719301663?idApp=WMIE" "url" => "/21735727/0000004300000007/v1_201910040722/S2173572719301663/v1_201910040722/en/main.assets" ] "en" => array:12 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Images in Intensive Medicine</span>" "titulo" => "Kernohan–Woltman notch phenomenon: Beware of the wrong side!" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:1 [ "paginaInicial" => "455" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "L.P. Maskin, A. Hlavnicka, N. Wainsztein" "autores" => array:3 [ 0 => array:4 [ "nombre" => "L.P." "apellidos" => "Maskin" "email" => array:2 [ 0 => "lmaskin@fleni.org.ar" 1 => "p_maskin@yahoo.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "A." "apellidos" => "Hlavnicka" ] 2 => array:2 [ "nombre" => "N." "apellidos" => "Wainsztein" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Intensive Care Unit, Raúl Carrea Neurological Research Institute, FLENI, Buenos Aires, Argentina" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Fenómeno de Kernohan-Woltman: ¡cuidado con el lado equivocado!" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 677 "Ancho" => 2400 "Tamanyo" => 165461 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Brain CT showed extended right-sided subdural haematoma (A), with compression of left cerebral peduncle against free tentorial (B, white arrow). Brain MRI reveals a rounded hyperintense T2 FLAIR (C) and DW1 (D) images in left cerebral peduncle (white arrow), at 2 days after initial injury.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">A 60-year-old woman, with past medical history of stroke (under treatment with aspirin and clopidogrel) presented with headache and incomplete palsy of III right cranial nerve. The patient referred a minor head trauma some days ago. Brain computed tomography (CT) showed an extended right-sided subdural haematoma (14<span class="elsevierStyleHsp" style=""></span>mm), with mass effect, and midline shifted to the left (10<span class="elsevierStyleHsp" style=""></span>mm) (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). A craniotomy and evacuation of the subdural collection was done. The patient awaked confused, with right-sided hemiparesis. Cervical spine pathology and stroke were excluded. Magnetic Resonance Image (MRI) of the brain showed changes in the contralateral cerebral peduncle, compatible with Kernohan–Woltman notch phenomenon. She was transferred to the general ward with moderate right-sided hemiparesis.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0010" class="elsevierStylePara elsevierViewall">Neurointensivists should recognize Kernohan–Woltman notch phenomenon as a paradoxical neurological manifestation of an ipsilateral motor deficit to the primary brain injury. The compression of the contralateral cerebral peduncle against the free tentorial, and the disruption of the corticospinal tract fibers above the medullary decussation, is the causes of this false localising neurological sign.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "multimedia" => array:1 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 677 "Ancho" => 2400 "Tamanyo" => 165461 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Brain CT showed extended right-sided subdural haematoma (A), with compression of left cerebral peduncle against free tentorial (B, white arrow). Brain MRI reveals a rounded hyperintense T2 FLAIR (C) and DW1 (D) images in left cerebral peduncle (white arrow), at 2 days after initial injury.</p>" ] ] ] ] "idiomaDefecto" => "en" "url" => "/21735727/0000004300000007/v1_201910040722/S2173572719301675/v1_201910040722/en/main.assets" "Apartado" => array:4 [ "identificador" => "64602" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Images in Intensive Medicine" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/21735727/0000004300000007/v1_201910040722/S2173572719301675/v1_201910040722/en/main.pdf?idApp=WMIE&text.app=https://medintensiva.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173572719301675?idApp=WMIE" ]
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