Ruptured Arteriovenous Malformation Presenting with Kernohan’s Notch
AVMs are congenital lesions that predispose patients to intracranial hemorrhage and resultant neurological deficits. These deficits are often focal and due to the presence of local neurologic disruption from hemorrhage in the contralateral cerebral hemisphere. We present a rare case of a patient wit...
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| Format: | Article |
| Language: | English |
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Wiley
2015-01-01
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| Series: | Case Reports in Neurological Medicine |
| Online Access: | http://dx.doi.org/10.1155/2015/921930 |
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| author | Christopher F. Dibble Michael P. Wemhoff Tarik Ibrahim Deanna Sasaki-Adams Sten Solander Anand V. Germanwala |
| author_facet | Christopher F. Dibble Michael P. Wemhoff Tarik Ibrahim Deanna Sasaki-Adams Sten Solander Anand V. Germanwala |
| author_sort | Christopher F. Dibble |
| collection | DOAJ |
| description | AVMs are congenital lesions that predispose patients to intracranial hemorrhage and resultant neurological deficits. These deficits are often focal and due to the presence of local neurologic disruption from hemorrhage in the contralateral cerebral hemisphere. We present a rare case of a patient with ipsilateral neurological deficits due to Kernohan’s Notch phenomenon resulting from hemorrhage from an AVM. A 31-year-old woman with seizures underwent MR and angiographic imaging which confirmed an unruptured left parietal AVM. The patient declined treatment and presented with obtundation 4 years later. Imaging revealed an acute left parietal ICH and SDH with significant mass effect. The patient underwent emergent hemicraniectomy and hematoma evacuation. Postoperatively, she made significant improvement and was following commands contralaterally with ipsilateral hemiplegia. MR imaging revealed right Kernohan’s Notch. The patient had significant rehabilitation with neurological improvement. She eventually underwent elective embolization followed by subsequent surgical resection and bone replacement. Three years from the initial hemorrhage, the patient had only mild left-sided weakness and ambulates without assistance. A false localizing sign, Kernohan’s Notch phenomenon, should be considered in the setting of AVM hemorrhage with paradoxical motor impairment and can be identified through MRI. |
| format | Article |
| id | doaj-art-630c063ddbb74cca9409eaed647441f6 |
| institution | Kabale University |
| issn | 2090-6668 2090-6676 |
| language | English |
| publishDate | 2015-01-01 |
| publisher | Wiley |
| record_format | Article |
| series | Case Reports in Neurological Medicine |
| spelling | doaj-art-630c063ddbb74cca9409eaed647441f62025-02-03T05:57:52ZengWileyCase Reports in Neurological Medicine2090-66682090-66762015-01-01201510.1155/2015/921930921930Ruptured Arteriovenous Malformation Presenting with Kernohan’s NotchChristopher F. Dibble0Michael P. Wemhoff1Tarik Ibrahim2Deanna Sasaki-Adams3Sten Solander4Anand V. Germanwala5Department of Neurological Surgery, University of North Carolina School of Medicine, Chapel Hill, NC 27514, USADepartment of Neurological Surgery, Loyola University School of Medicine, Maywood, IL 60153, USADepartment of Neurological Surgery, Loyola University School of Medicine, Maywood, IL 60153, USADepartment of Neurological Surgery, University of North Carolina School of Medicine, Chapel Hill, NC 27514, USADepartment of Radiology, University of North Carolina School of Medicine, Chapel Hill, NC 27514, USADepartment of Neurological Surgery, Loyola University School of Medicine, Maywood, IL 60153, USAAVMs are congenital lesions that predispose patients to intracranial hemorrhage and resultant neurological deficits. These deficits are often focal and due to the presence of local neurologic disruption from hemorrhage in the contralateral cerebral hemisphere. We present a rare case of a patient with ipsilateral neurological deficits due to Kernohan’s Notch phenomenon resulting from hemorrhage from an AVM. A 31-year-old woman with seizures underwent MR and angiographic imaging which confirmed an unruptured left parietal AVM. The patient declined treatment and presented with obtundation 4 years later. Imaging revealed an acute left parietal ICH and SDH with significant mass effect. The patient underwent emergent hemicraniectomy and hematoma evacuation. Postoperatively, she made significant improvement and was following commands contralaterally with ipsilateral hemiplegia. MR imaging revealed right Kernohan’s Notch. The patient had significant rehabilitation with neurological improvement. She eventually underwent elective embolization followed by subsequent surgical resection and bone replacement. Three years from the initial hemorrhage, the patient had only mild left-sided weakness and ambulates without assistance. A false localizing sign, Kernohan’s Notch phenomenon, should be considered in the setting of AVM hemorrhage with paradoxical motor impairment and can be identified through MRI.http://dx.doi.org/10.1155/2015/921930 |
| spellingShingle | Christopher F. Dibble Michael P. Wemhoff Tarik Ibrahim Deanna Sasaki-Adams Sten Solander Anand V. Germanwala Ruptured Arteriovenous Malformation Presenting with Kernohan’s Notch Case Reports in Neurological Medicine |
| title | Ruptured Arteriovenous Malformation Presenting with Kernohan’s Notch |
| title_full | Ruptured Arteriovenous Malformation Presenting with Kernohan’s Notch |
| title_fullStr | Ruptured Arteriovenous Malformation Presenting with Kernohan’s Notch |
| title_full_unstemmed | Ruptured Arteriovenous Malformation Presenting with Kernohan’s Notch |
| title_short | Ruptured Arteriovenous Malformation Presenting with Kernohan’s Notch |
| title_sort | ruptured arteriovenous malformation presenting with kernohan s notch |
| url | http://dx.doi.org/10.1155/2015/921930 |
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