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The Kernohan-Woltman Notch Phenomenon : A Systematic Review of Clinical and Radiologic Presentation, Surgical Management, and Functional Prognosis

  • Beucler, Nathan;Cungi, Pierre-Julien;Baucher, Guillaume;Coze, Stephanie;Dagain, Arnaud;Roche, Pierre-Hugues
    • Journal of Korean Neurosurgical Society
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    • v.65 no.5
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    • pp.652-664
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    • 2022
  • The Kernohan-Woltman notch phenomenon (KWNP) refers to an intracranial lesion causing massive side-to-side mass effect which leads to compression of the contralateral cerebral peduncle against the free edge of the cerebellar tentorium. Diagnosis is based on "paradoxical" motor deficit ipsilateral to the lesion associated with radiologic evidence of damage to the contralateral cerebral peduncle. To date, there is scarce evidence regarding KWNP associated neuroimaging patterns and motor function prognostic factors. A systematic review was conducted on Medline database from inception to July 2021 looking for English-language articles concerning KWNP, in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The research yielded 45 articles for a total of 51 patients. The mean age was 40.7 years-old and the male/female sex ratio was 2/1. 63% of the patients (32/51) suffered from head trauma with a majority of acute subdural hematomas (57%, 29/51). 57% (29/51) of the patients were in the coma upon admission and 47% (24/51) presented pupil anomalies. KWNP presented the neuroimaging features of compression ischemic stroke located in the contralateral cerebral peduncle, with edema in the surrounding structures and sometimes compression stroke of the cerebral arteries passing nearby. 45% of the patients (23/51) presented a good motor functional outcome; nevertheless, no predisposing factor was identified. A Glasgow coma scale (GCS) of more than 3 showed a trend (p=0.1065) toward a better motor functional outcome. The KWNP is a regional compression syndrome oftentimes caused by sudden and massive uncal herniation and leading to contralateral cerebral peduncle ischemia. Even though patients suffering from KWNP usually present a good overall recovery, patients with a GCS of 3 may present a worse motor functional outcome. In order to better understand this syndrome, future studies will have to focus on more personalized criteria such as individual variation of tentorial notch width.

Detection of Cerebrovascular Disease in a Child with Hutchinson-Gilford Progeria Syndrome Using MR Angiography: A Case Report (Hutchison-Gilford 조로증 증후군 환아에서의 뇌 자기공명 혈관조영술 소견: 증례 보고)

  • Jae Ho Lee;Ha Young Lee;Myung Kwan Lim;Young Hye Kang
    • Journal of the Korean Society of Radiology
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    • v.83 no.6
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    • pp.1360-1365
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    • 2022
  • Hutchinson-Gilford progeria syndrome (HGPS) is a rare, progressive, premature aging syndrome with early morbidity due to cardiovascular and cerebrovascular diseases. Clinical symptoms are very diverse, including non-specific symptoms such as growth retardation, scleroderma, alopecia, and osteoporosis, as well as hypertension and cardiovascular diseases that occur in childhood and adolescence due to accelerated vascular aging. In patients with HGPS, MR angiography is recommended for early diagnosis of asymptomatic stroke or vascular changes and to assess increased risk of cerebrovascular disease. We report the second domestic case of HGPS confirmed by genetic analysis in a 5-year-old child with typical clinical features, and the first English case report in Korea to present brain MR angiography findings.

Extremely Rare CT and MRI Findings of Peritoneal Leiomyoma Mimicking Hepatic Mass: A Case Report (매우 드문 간종괴로 오인된 복막 평활근종의 CT 및 MRI 소견: 증례 보고)

  • Jonghun Woo;Seo-Youn Choi;Hee Kyung Kim;Ji Eun Lee;Min Hee Lee;Sanghyeok Lim
    • Journal of the Korean Society of Radiology
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    • v.84 no.4
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    • pp.946-951
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    • 2023
  • Leiomyoma is a common benign tumor from smooth muscle cells, mostly in the uterus. Peritoneal leiomyomas (PLs) are extremely rare and mostly reported as disseminated peritoneal leiomyomatosis. However, to the best of out knowledge, radiologic findings of isolated PL are not reported in English literature. Herein, we introduce the radiologic findings of PL mimicking hepatic mass in a 34-year-old female. CT showed a mass with curvilinear heterogeneous enhancement at the liver's peripheral area. On MRI, the mass showed gradual and heterogeneous enhancement on gadoxetic acid-enhanced MRI and diffusion restriction. The radiologic diagnosis was a benign hepatic tumor, such as degenerated hemangioma, adenoma, and inflammatory myofibroblastic tumor; however, the mass was diagnosed as PL pathologically.

MRI Findings of Renal Myxoma: A Case Report and Literature Review (신장 점액종의 MRI 소견: 증례 보고와 문헌고찰)

  • Sung Hyun Yu;Young Sup Shim;So Hyun Park;Seung Joon Choi;Dong Hae Chung;Sang Jin Yoon
    • Journal of the Korean Society of Radiology
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    • v.83 no.1
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    • pp.162-167
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    • 2022
  • Renal myxomas are very rare benign tumors. To date, a few cases have been reported in English literature, mostly in pathology and urology journals. Thus, there are few reports on the radiological findings associated with renal myxomas. We report on the imaging findings in a case of renal myxoma in a 62-year-old male. MRI demonstrated a well-defined mass in the left renal sinus, with intermediate high signal intensity on T2-weighted images and low signal intensity on T1-weighted images. The tumor showed gradual enhancement on contrast-enhanced T1-weighted images.

Carotid Vessel Wall MRI Findings in Acute Cerebral Infarction Caused by Polycythemia Vera: A Case Report (적혈구 증가증으로 인한 급성 뇌경색에서 경동맥 혈관벽 자기공명영상 소견: 증례 보고)

  • Jun Kyeong Park;Eun Ja Lee;Dong-Eog Kim;Hyun Jung Lee
    • Journal of the Korean Society of Radiology
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    • v.83 no.1
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    • pp.178-183
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    • 2022
  • Polycythemia vera (PV) is a rare myeloproliferative disease that causes elevated absolute red blood cell (RBC) mass due to uncontrolled RBC production. Moreover, this condition has been associated with a high risk of ischemic stroke and large vessel stenosis or occlusion, with many studies reporting cerebral infarction in PV patients. Despite these findings, there have been no reports on the vessel wall MRI (VW-MRI) findings of the narrowed vessels in PV-associated ischemic stroke patients. To the best of our knowledge, this is the first report in English regarding the carotid VW-MRI findings of a 30-year-old male diagnosed with PV after being hospitalized due to stroke.

Radiologic Findings of Mesonephric-Like Adenocarcinoma of the Uterine Corpus: A Case Report (자궁 체부에 발생한 중신 유사 선종의 영상 소견: 증례 보고)

  • Ha Jung Kim;Kyeong Ah Kim;Yikyeong Chun;Jeong Woo Kim;Jongmee Lee;Chang Hee Lee
    • Journal of the Korean Society of Radiology
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    • v.84 no.3
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    • pp.698-704
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    • 2023
  • According to the 2020 World Health Organization classification, mesonephric-like adenocarcinoma (MLA) is newly categorized as a subtype of endometrial carcinoma and remains a relatively unknown disease owing to its rarity. To the best of our knowledge, radiological findings of MLA have not been reported in the English literature. The uterine MLAs show a worse clinical prognosis and a more aggressive biological behavior than the usual endometrial carcinoma. Herein, we present the imaging findings of a 65-year-old female with a MLA in the uterine corpus. The tumor was a solid endometrial mass with deep myometrial invasion, poor contrast enhancement, and moderate diffusion restriction.

Primary Malignant Melanoma of the Breast Presenting as a Breast Abscess: A Case Report (유방 농양으로 발현한 유방의 원발성 악성 흑색종: 증례 보고)

  • Hyung In Choi;You Me Kim;Junwon Min;Yong Moon Lee;Hee Jeong Kim
    • Journal of the Korean Society of Radiology
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    • v.84 no.3
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    • pp.763-769
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    • 2023
  • Primary malignant melanoma in breast parenchyma (PMB) is an extremely rare disease, and the most common presentation is a palpable breast lump. To the best of our knowledge, a case of PMB presenting as a breast abscess has not been reported in English literatures. We present a case of PMB that manifested as a recurrent breast abscess in a 71-year-old woman. On MRI, an enhancing solid mass with a cystic or necrotic portion was revealed with some high signal intensities on precontrast-enhanced T1-weighted images and a dark rim on T2-weighed images. The MRI features played a pivotal role in identifying the underlying malignant condition and making an accurate diagnosis of this rare case of PMB with unusual clinical presentation.

Hepatic Cirrhosis Secondary to chronic Hepatitis in an English Cocker Spaniel (ECS) Dog (잉글리쉬 코커스파니엘 견에서 발생한 만성 간염 및 간경화 증례)

  • Park Chul;Yoo Jong-Hyun;Jung Dong-In;Kim Ha-Jung;Kang Byeong-Teck;Lim Chae-Young;Yoon Hun-Young;Jeong Soon-Wuk;Sur Jung-Hyang;Park Hee-Myung
    • Journal of Veterinary Clinics
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    • v.23 no.1
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    • pp.72-76
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    • 2006
  • A 1-year-old, female English cocker spaniel (ECS) dog was presented with 3-month history of vomiting and retaking of the vomitus, and chronic weight loss. The client had noticed mild abdominal distension 10 days before. The dog was diagnosed as chronic hepatitis with hepatic cirrhosis based on complete blood count (CBC), serum chemistry profiles, radiography, ascites assessment, bile acid evaluation, and liver biopsy through exploratory laparotomy and necropsy. CBC and serum chemistry profiles revealed mild anemia, slightly elevated hepatic enzymes (ALT and AST), increased creatinine kinase (CK), hyperammonemia, and hypoproteinemia with hypoalbuminemia. Ascites was transudate according to analysis of components. Bile acid assessment (fasting; $174.4{\mu}mol/L$ and postprandial; $198.4{\mu}mol/L$) showed strongly suspected hepatic insufficiency. On radiological findings, ascites was evident. Atrophied liver (especially left side lobes) and distended mesenteric vasculatures were observed by exploratory laparotomy. Histopathological examination of marginal lesion of left lateral lobe of liver by biopsy revealed the necrosis of hepatic cells, dilation of sinusoids, infiltration of neutrophils in sinusoids, and vacuolation of hepatic cytoplasm. The patient had been managed with careful low protein diet and specific supportive therapy (ursodeoxycholic acid, prednisolone, vitamine E, and interferon). Vomiting and ascites disappeared with medical management. The dog was monitored periodically by CBC, serum chemistry and radiographic examination. The dog survived more 18 months with medical therapy. After spontaneous death, necropsy and histopathologic examination were performed.

A Case Study of Possession Display Pattern as a Mean of Self-identity Expression in Older People's Households (아이덴티티를 표현하는 노인가정의 소유물 배치패턴 사례연구)

  • Choi, Jung-Shin
    • Journal of the Korean housing association
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    • v.18 no.5
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    • pp.65-72
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    • 2007
  • What is the meaning of home to older people? How much is home significant for older people? How do they express self-identity through decorating their own homes? These are the new subjects that scholars in the West are involved in lately in terms of micro-perspective (George, 1998; Kellett, Gilroy & Jason, 2005; Gilroy & Kellett, 2006). It is evident that home has more significant meaning to older people than other age groups, since the older are more likely to spend greater time within the home through lower income, lessening mobility or loss of companions (Gilroy, 2005). Also the older tend to cling to their homes and attach to possessions than the younger. Older people's possessions are the things that memories of their lives were absorbed. Therefore, possession display can role as a mean of showing their past lives and memories. Gilroy and her colleagues (2005, 2006) found that there was a certain pattern of possession display in English older people's households, and that older people would like to express self-identity through decorating their own homes with their precious possessions. Then, isn't it interesting to find out if there is any pattern of possession display or decoration items in Korean older people's households as well? Thus, the aim of this study is to describe pattern of possession display as a mean of expressing self-identity in Korean older people's households. Interview with older people was used to find out the way and reason of display possessions. Observation method including taking photos and hand-drawings was also added in order to demonstrate detail condition of display items in the house. Possessions display and furniture arrangement in the living room and bedroom were investigated to find out a certain pattern of display and meaning. Research objects were healthy older people aged over 60, who are living independently from their adult children, and who can manage housekeeping by themselves. 32 households were investigated in the area of Seoul, Kyunggi, Chungchungnam, and Kangwon provinces. The findings demonstrate that most precious possession for Korean older people is photo of themselves; especially one taken in their younger age. The reason of it is because the photo reminds them of their heydays when they were vital. Photo of the most beloved one is displayed more frequently in the bedroom than in the living room indicating consistence with English case. As symmetrical display pattern was dominant in case of English older people's households, no dominant display pattern is found in Korean case. Korean older people also cling to their homes and possessions and want to keep their dwelling space as large as what they use now. It is notable that even after they become older and frail, they want sufficient space to display possessions as a mean of self-identity expression. Attachment to possessions and decoration can give older people significant meaning of identity, and it is the reason why architects or interior designers have to meet older people's needs. It needs consideration that residents are allowed to bring their old furniture and precious possessions when they move in elderly housing unit in order to minimize environmental shock, as well as feeling at home. This subject could suggest a clue to designers or architects who have to meet residents' needs in space design of elderly housing or facilities in the future. Psychological well-being of older people can be met by making them feel at home wherever they live. They need space where they can express their own identity and personality even in case when they have to live in a limited small space like elderly housing unit or nursing home.

Review of Fish Name on the Fishes of the Family Mugilidae in Korea and Resource Utilization (우리나라 숭어과 어류의 어명 및 자원 활용에 대한 고찰)

  • Ko, Eun Young;Park, Jong Oh;Lee, Kyoung Seon
    • Journal of Marine Life Science
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    • v.4 no.2
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    • pp.96-105
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    • 2019
  • The mugilidae fishes are common euryhaline species that live in coastal marine waters to freshwater areas. The taxonomy and nomenclature of the mugilidae fishes still remain unresolved because of their morphological similarities. Among the mugilidae fishes, most commonly consumed in Korea, are grey mullet (Mugil cephalus) and red lip mullet (Chelon haematocheilus). It is generally called 'mullet' without distinguishing between two mullets. Therefore, the aim of this study is to examine the scientific names and common names of mullet species used in Korea from the domestic journals and Korean old documents. The scientific name of grey mullet is M. cephalus, but that of redlip mullet is C. haematocheilus. But the genus of redlip mullet is still mixed with Chelon, Mugil, and Liza. The standard name of two mullet is not distinguished in the Korean dictionary, but they were clearly distinguished in the Japanese, English, and Chinese dictionaries. In the ancient Korean references, the mullet was called 'Chieo' or 'Sueo'. In most of the old literature, the distinction between grey mullet and redlip mullet is not clear. However, in Jasaneobo, it was written separately from grey mullet and redlip mullet, and attaching "ga" was different from now. The Korean standard name of redlip mullet is 'gasungeo', however, the fishermen in Jeollado and Gyoungsangdo call it 'chamsungeo'. Considering the negative perception of 'ga' character, it is proposed to change 'cham(眞)' instead of 'ga(假)' to improve economic value of red lip mullet.