Kernohan-Woltman Notch Phenomenon in Chronic Subdural Hematoma: An under-Diagnosed Phenomenon?

Introduction: Kernohan-Woltman notch phenomenon is a neurological picture of mydriasis and hemiparesis/ hemiplegia ipsilateral to a supratentorial mass lesion causing compression of the contralateral cerebral peduncle against the tentorial edge. The aim of this paper is to report series of cases from a low volume centre of neurosurgical care and highlight the fact that Kernohan’s notch phenomenon, although, reported to be quite rare but it’s not uncommon and to also look out for this phenomenon to avoid wrong site surgeries. Presentation of Cases: We report four cases of chronic subdural hematoma presenting with Kernohan- Woltmann notch phenomenon. The patients include: a young alcoholic who was found in a gutter after binge drinking, a middle aged man who was accidentally hit on the head with a car tire jack, an elderly female with no history of trauma, a fall nor use of anticoagulant and an elderly male, a diabetic. All four patients had emergency burr hole and drainage of subdural hematoma. Discussion: This incidence of this phenomenon among patients with chronic subdural hematoma is rarely reported in the literature, however, a low volume centre for neurosurgical services like ours has seen five cases in a short period of time. Conclusion: This paradoxical neurological sign is probably under-diagnosed judging from the number of cases diagnosed in a low volume center like ours.

Descending transtentorial herniation, a rare complication of the treatment of trapped fourth ventricle: case report

Descending transtentorial herniation (DTH) is a complication of raised pressure in the supratentorial compartment, usually resulting from mass lesion of several etiologies. The authors report an exceptional case of DTH complicating the implant of a CSF shunting device in the trapped fourth ventricle of a 17-year-old boy in whom a second CSF shunting device had been implanted for neonatal posthemorrhagic and postinfectious hydrocephalus. The insidious clinical and radiological presentation of DTH, mimicking a malfunction of the supratentorial shunt, is documented. Ultimately, the treatment consisted of removal of the infratentorial shunt and endoscopic acqueductoplasty with stenting. The absence of supratentorial mass lesion and other described etiologies of DTH prompted the authors to speculate on the hydrodynamic pathogenesis of DTH in the present case.

Case 10.26

32-year-old woman with abnormal obstetric US Coronal oblique fat-suppressed 2D SSFP images (Figure 10.26.1) show a complex cystic and solid supratentorial mass replacing most of the fetal brain. Note also macrocephaly and polyhydramnios. Fetal intracranial teratoma Fetal and congenital tumors represent less than 3% of all tumors diagnosed before age 15 years. The reported incidence of congenital tumors ranges from 1.7 to 13.5 per 100,000 live births and is likely greater in stillborn and aborted fetuses. If the definition of ...