Magnetic resonance imaging findings of Kernohan-Woltman notch in acute subdural hematoma

Objective and importance : We report the case of a 73-year-old patient who presented a right motor deficit caused by an ipsilateral acute subdural hem atoma. A magnetic resonance imaging (MRI) demonstration of Kernohan-Woltman notch phenomenon was obtained. Clinical presentation: The woman sustained a major head injury at home, followed by loss of consciousness. On admissio n to the emergency room, she was comatose, anisochoric (left > right), and showed a reaction to pain with decerebrating movements of left limbs (Glasg ow Coma Scale (GCS) 4/15). A right severe hemiparesis was observed. Cerebra l computed tomography scan showed a large right hemispheric subdural hemato ma. Intervention and post-operative course: A wide right craniotomy was per formed and the subdural hematoma evacuated. During the post-operative perio d, the level of consciousness gradually improved. A MRI performed about 2 w eeks after operation showed a small area of abnormal signal intensity in th e left cerebral peduncle. On discharge, the woman was able to communicate w ith others, but her right hemiparesis was still severe. (C) 1999 Elsevier S cience B.V. All rights reserved.