Ipsilateral Motor Deficit Research Articles

Kernohan-Woltman Notch Phenomenon Following Acute Subdural Hematoma

A 72-year-old right-handed female patient was operated on for left-sided acute subdural hematoma responsible for coma. Two weeks afterward, her neurological status had improved with a Glasgow Coma Scale score of 14 and a paradoxical left-sided hemiparesis. The brain magnetic resonance imaging displayed a diffusion-restricting, hyper fluid-attenuated inversion recovery lesion of the right cerebral peduncle facing the tentorial notch, and the patient was diagnosed with Kernohan-Woltman notch phenomenon. This allowed to focus the neurological rehabiliation on the ipsilateral motor deficit as well as the hemineglect.

Relationship between Ipsilateral Motor Deficits on the Less-Affected Side and Motor Function Stage on the Affected Side

Purpose: Aim of this study was to investigate whether there are ipsilateral motor deficits for visuospatial accuracy and fine movements by making a comparison between stroke patients and healthy subjects. We examined whether ipsilateral motor deficits are influenced by the level of functional movements and muscle strength of the upper and lower extremities of the affected side. Methods: Thirty post-stroke subjects and 20 normal aged matched subjects were recruited. Outcome measures for less-affected side were the tracking task and nine-hole pegboard test. Fugl-Meyer test and motricity index were applied for the measurement of functional movements and muscle strength of affected side. Results: Tracking task and nine-hole pegboard test was significantly different between control and experimental group. In terms of accuracy index according to tracking, the experimental group showed a lower accuracy index in the MCP joint than the control group. However, there were no significant difference relation between the level of motor function of the affected side and the motor deficit level of ipsilateral side. Conclusion: Ipsilateral motor deficits may have significant clinical implications. It needs to be noted that although many patients, families, and medical staff are focused only on motor deficits of the affected side, motor deficits of the sound side can cause difficulties in daily living movements requiring delicate movements. In addition, there was no significant correlation between the level of motor function of the affected side and motor deficits of the sound side.

Motor Symptoms in Brain Stem Lesion

Palatal tremor and Kernohan-Woltman notch phenomenon are rare motor symptoms that can show up in patients with lesion in brain stem or cerebellum. Patients with palatal tremor accompany ataxia, internuclear ophthalmoplegia, dysphagia, dysarthria and Kernohan-Woltman notch phenomenon causes ipsilateral motor deficits. Although its rarity, these conditions exhibit unexpected symptoms as well as considerable disability, which can raise etiologic and prognostic concerns for rehabilitation team. These two motor symptoms are discussed in this review. (Brain & NeuroRehabilitation 2014; 7: 101-104)

Fenómeno de Kernohan-Woltman secundario a un hematoma epidural craneal

Kernohan-Woltman notch phenomenon is a paradoxical neurological manifestation which involves a motor deficit on the same side as the primary brain injury. It is produced mainly by acute or chronic subdural hematomas, and less frequently by post-traumatic epidural ones. It should be taken into consideration in cases of ipsilateral motor deficit, as it may lead to surgical procedures being performed on the incorrect side. We report the case of a 40 year old man who sustained a major head injury which was followed by a decreased level of consciousness and anisocoria. Computed tomography of the brain revealed a frontal and parietal epidural hematoma with right midline shift and uncal herniation. Craniotomy and drainage of the hematoma was performed, and on the sixth day after surgery it was observed that the patient had a brachio-crural right hemiparesis. Magnetic resonance imaging showed an ischemic area on the left capsule and cerebral peduncle consistent with the diagnosis of Kernohan-Woltman notch phenomenon.

Cervical Disc Herniation Causing Brown-Séquard's Syndrome: A Case Report and Literature Review

Brown-Séquard's syndrome (BSS) is caused by hemisection or hemicompression of the cord leading to ipsilateral motor deficit and contralateral sensory loss. Cervical disc herniation has been reported to be a rare cause of Brown-Séquard's syndrome. We describe a rare case of multilevel cervical disc herniation presenting as BSS. The condition was confirmed by MRI scan. Cervical corpectomy, decompression, and fusion gave a satisfying result. Pertinent literature has been reviewed.

Kernohan-Woltman notch phenomenon caused by an acute subdural hematoma

Uncal herniation through the tentorial notch is occasionally associated with false localizing ipsilateral hemiparesis, known as the Kernohan-Woltman notch phenomenon (KWNP). We report an 81-year-old female who presented with a decreased level of consciousness, a right mydriasis and an ipsilateral motor deficit caused by a large right hemispheric subdural hematoma that was immediately evacuated. The patient recovered well, although her right hemiplegia persisted. A follow-up MRI showed a residual lesion in the left cerebral peduncle, corresponding to KWNP. The presence of such a structural lesion suggests a poor prognosis for recovery from the initial motor deficit.

Brown-Sequard syndrome associated with Horner’s syndrome following a penetrating drill bit injury to the cervical spine

We report a 41-year-old male who presented with a partial Brown-Sequard syndrome and Horner’s syndrome following a penetrating drill bit injury to his mid cervical spine. As the injury was not a complete hemisection of the spinal cord, the patient presented with ipsilateral motor deficit and hyperesthesia and diminished contralateral fine touch sensation; however, proprioception, vibration and temperature were all initially intact. A cervical CT and MRI scan showed a damaged spinal cord at the C5/6 level with posterior cord compression secondary to haematoma. A decompressive laminectomy and evacuation of the haematoma was performed. Over the following 5 days the patient’s right-sided motor deficit improved daily; however, he developed a contralateral deficit to pain and temperature upon wakening from the operation which did not resolve. The right-sided Horner’s syndrome also persisted.

Hemimedullary infarct with ipsilateral hemiplegia: A vertebral artery dissection syndrome?

Background Hemimedullary syndrome is very rare and combines the clinical features of lateral and medial medullary infarctions. In patients with hemimedullary syndrome, the presence of ipsilateral, rather than contralateral hemiplegia, is rare. Objective To describe a patient with an infarction in the right hemimedulla with an ipsilateral motor deficit due to dissection of the right vertebral artery (VA) and to assess whether the ipsilateral hemiplegia may be the result of a specific stroke mechanism. Methods We reviewed the reports of hemimedullary syndrome in the literature and compared the characteristics of patients with dissection of the VA with those with VA atherosclerotic disease. Results In our patient, magnetic resonance angiography showed dissection of the right VA to be the cause of the stroke. In a review of the literature (including our case), hemiplegia was ipsilateral to the infarction in four of the five patients with VA dissection, but contralateral in all six patients with atherosclerotic disease of the VA ( p = 0.01). In all five cases of VA dissection, the right hemimedulla was involved, while, in the six cases of atherosclerotic disease, the left side of the medulla oblongata was affected in five instances and the right side in one ( p = 0.01). Conclusion Dissection of the VA may provoke a hemimedullary lesion at a lower level than atherosclerosis, thus affecting medullary-penetrating branches that irrigate the medulla immediately below the pyramidal decussation. Hemimedullary syndrome accompanied by ipsilateral motor deficit should raise suspicion of dissection of the VA.

Sensory Deficits in the Unaffected Hand of Hemiparetic Stroke Patients

To evaluate sensory function in the unaffected hand of unilateral stroke patients. Ipsilateral motor deficits have been described in stroke patients, but sensory function has usually been reported to be normal in the unaffected limbs. Twenty-five patients (19 males, 6 females, 58.24+/-11.11 y old) with first-ever stroke, in the chronic phase (mean interval after stroke: 43.8+/-55.4 mo), who fulfilled the inclusion criteria, and 25 age-matched and sex-matched healthy control subjects (19 males, 6 females, 58.60+/-11.32 y old) participated in the study. Ipsilateral hand sensory function was assessed with a Moving Touch-Pressure test; motor performance was evaluated by the Box and Block test and grip strength. The examiner was not blinded to the subject's neurologic status. Stroke patients had a mean Moving Touch-Pressure score of 79.77%+/-10.74% whereas the control group had a mean score of 89.10%+/-8.09% (P<0.01). Mean Box and Block scores were 58.4+/-8.27 and 68.08+/-8.98, respectively (P<0.01). In addition to motor dysfunction, decreased sensitivity to moving tactile stimuli may contribute to clumsiness of the unaffected arm of unilateral stroke patients.

Ipsilateral motor dysfunction from unilateral stroke: implications for the functional neuroanatomy of hemiparesis

Background:Motor dysfunction in the contralateral hand has been well characterised after stroke. The ipsilateral hand has received less attention, yet may provide valuable insights into the structure of the motor...

Kernohan-Woltman notch phenomenon: An unusual cause of ipsilateral motor deficit

Posttraumatic ipsilateral motor deficits are rare and raise etiologic and prognostic concerns for the rehabilitation team. We present two cases with an unusual central neurologic cause of ipsilateral weakness. The first patient was assaulted, with a resultant severe traumatic brain injury. Initial computed tomography showed a large right subdural hematoma (SDH) with significant mass effect. Following a craniotomy for evacuation of the SDH, the patient was noted to have paradoxical rightsided (ipsilateral) motor deficits. Postoperative magnetic resonance imaging (MRI) showed compression of the contralateral (left) cerebral peduncle against the tentorium, thus resulting in ipsilateral (right-sided) motor weakness (the Kernohan-Woltman notch phenomenon). Prior limited reports carried a grave prognosis for these patients. On discharge from inpatient rehabilitation, the patient was functioning at a Rancho Los Amigos Scale VI. The second patient was involved in a motor vehicle accident and was found to have a large left frontotemporal subdural hematoma with shift. A dense left hemiplegia was noted after hematoma evacuation. MRI also showed a right cerebral peduncle hypointensity. At discharge, the patient was rated a Rancho Los Amigos Scale VI. Physiatrists need to be aware of the causes of ipsilateral motor weakness as well as the limitations of prognostic data.