Kernohan's notch and misdiagnosis of disorders of consciousness.

Details

Serval ID
serval:BIB_5F5E78A9D38B
Type
Article: article from journal or magazin.
Publication sub-type
Case report (case report): feedback on an observation with a short commentary.
Collection
Publications
Title
Kernohan's notch and misdiagnosis of disorders of consciousness.
Journal
Bmj Case Reports
Author(s)
Simonin A., Levivier M., Nistor S., Diserens K.
ISSN
1757-790X (Electronic)
Publication state
Published
Issued date
2014
Volume
02
Pages
-
Language
english
Notes
Publication types: Case Reports ; Journal Article
Publication Status: epublish
Abstract
A 69-year-old man presented with a sudden headache followed by unconsciousness. There was no head injury. The Glasgow Coma Scale (GCS) score was 3/15 and there was a left mydriasis, unreactive to light. The CT-scan showed a left acute subdural haematoma causing a remarkable mass effect. A supratentorial hemispheric craniotomy was performed. Nevertheless, after several weeks at the intensive care unit (ICU), the patient was still unresponsive to external stimuli and did not show any motor activity. A comfort care attitude was decided on with the family and the patient was extubated. However, a few days later, the patient subsequently showed a surprisingly favourable course, with improved wakefulness. Indeed, the GCS score improved, and the treatment plan was modified so that the patient benefited from rehabilitation. The MRI showed a right cerebral peduncle lesion, consistent with a Kernohan-Woltman notch phenomenon (KWNP). Six months later, the patient was able to walk and live quite normally.
Keywords
Aged, Anisocoria/etiology, Craniotomy, Diagnostic Errors, Hematoma, Subdural, Acute/complications, Hematoma, Subdural, Acute/diagnosis, Hemiplegia/etiology, Humans, Magnetic Resonance Imaging, Male, Mydriasis/etiology, Tegmentum Mesencephali/pathology, Tomography, X-Ray Computed, Unconsciousness/diagnosis, Unconsciousness/etiology
Pubmed
Create date
04/11/2014 18:01
Last modification date
20/08/2019 15:17
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