Kernohan-woltman phenomenon in vertex epidural hematoma. Case of neurocritical management.

Abstract

It is the name of the paradoxical deficit of the ipslateral hemibody at the supratentorial pressure focus, product of the compression of the cerebral peduncle contralateral to the herniation, towards the tentorial free edge and interruption of the corticospinal fibers; it is considered "a sign of false location that puts the neurologist and neurosurgeon to shame"; it is represented in the image as a notch in the affected peduncle; it is rare in epidural hematomas. This is a 33-year-old patient, who suffered an axial impact in the vertex, with an interparietal fracture that caused injury to the upper sagittal sinus in its three thirds; He attended with a Glasgow Scale of six, with anisocoria and ipsilateral hemiplegia, with biparietal epidural hematoma, repair surgery of the superior sagittal sinus and modified decompressive hemicraniectomy towards the midline, the objective is to discuss the characteristics of the trauma, management surgical and case prognosis.