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

Abstract

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.