Delayed Hemiparkinsonism Associated with Kernohan's Notch in a Patient with a Ruptured Arteriovenous Malformation

A 24-year-old female patient was admitted for a right frontal intracranial hematoma with an uncal herniation due to a ruptured arteriovenous malformation and therefore underwent emergency surgery. Neuroimaging revealed left-sided midbrain notching against the tentorium, indicating Kernohan's no...

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Published inInternal Medicine Vol. 60; no. 2; pp. 309 - 313
Main Authors Ueda, Masayuki, Tsunogae, Marie, Saito, Hiroshi, Suzuki, Takeya, Ota, Takahiro
Format Journal Article
LanguageEnglish
Published Japan The Japanese Society of Internal Medicine 15.01.2021
Japan Science and Technology Agency
Subjects
Adult
arteriovenous malformation
Arteriovenous Malformations
Case Report
Degeneration
Dopamine transporter
Female
Hematoma
hemiparkinsonism
Humans
Internal medicine
Kernohan's notch phenomenon
Magnetic Resonance Imaging
Mesencephalon
Neostriatum
Neuroimaging
Neurological diseases
Surgery
trihexyphenidyl
uncal herniation
Young Adult
arteriovenous malformation
Kernohan's notch phenomenon
trihexyphenidyl
hemiparkinsonism
uncal herniation
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Summary:A 24-year-old female patient was admitted for a right frontal intracranial hematoma with an uncal herniation due to a ruptured arteriovenous malformation and therefore underwent emergency surgery. Neuroimaging revealed left-sided midbrain notching against the tentorium, indicating Kernohan's notch phenomenon. She denied experiencing any short-term neurological deficits but right-sided delayed hemiparkinsonism developed 18 months later. Dopamine transporter tracer uptake was severely reduced in the left striatum, suggesting nigrostriatal degeneration secondary to Kernohan's notch. Uncal herniations are potentially fatal, but surgery can save the patient's life and improve the functional outcomes. Clinicians should therefore be aware of delayed hemiparkinsonism as a rare complication of Kernohan's notch phenomenon.
Bibliography:ObjectType-Case Study-2
SourceType-Scholarly Journals-1
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Correspondence to Dr.　Masayuki Ueda, ueda@nms.ac.jp
ISSN:0918-2918
1349-7235
DOI:10.2169/internalmedicine.5621-20