Kernohan-Woltman Notch Phenomenon in Two Patients with Subdural Hematoma and Ipsilateral Hemiparesis.

ABSTRACT

CASE 1 A 9-yr-old boy presents with right subdural hematoma and ipsilateral hemiparesis. Clinical presentation and imaging are consistent with Kernohan-Woltman notch phenomenon. CASE 2 A 19-yr-old man presents with right subdural hematoma and ipsilateral hemiparesis. Clinical presentation is consistent with Kernohan-Woltman notch phenomenon. CLINICAL PEARL Kernohan-Woltman notch phenomenon is a false-localizing neurologic sign that presents with hemiparesis ipsilateral to the primary lesion. It occurs in the setting of transtentorial herniation, during which the contralateral cerebral peduncle is compressed against the free edge of the tentorium, causing compression of descending corticospinal tract fibers.