Transcranial Motor Evoked Potential Recording in a Case of Kernohan's Notch Syndrome: Case Report

Neurosurgery ◽  
2004 ◽  
Vol 54 (4) ◽  
pp. 999-1003 ◽  
Author(s):  
Devin K. Binder ◽  
Russ Lyon ◽  
Geoffrey T. Manley
Keyword(s):  
Evoked Potential ◽  
Motor Evoked Potential ◽  
Cerebral Peduncle ◽  
Resonance Imaging ◽  
Left Hemiparesis ◽  
Electrophysiological Studies ◽  
Electrophysiological Findings ◽  
The Right ◽  
Tentorial Incisura ◽  
Potential Waveform

Abstract OBJECTIVE AND IMPORTANCE Compression of the cerebral peduncle against the tentorial incisura contralateral to a supratentorial mass lesion, the so-called Kernohan-Woltman notch phenomenon, can be an important cause of false localizing motor signs. Here, we demonstrate a case in which clinical, radiological, and electrophysiological findings were used together to define this syndrome. CLINICAL PRESENTATION A 21-year-old man sustained a left temporal depressed cranial fracture from a motor vehicle accident. Serial computed tomographic examinations demonstrated no evolution of hematomas or contusions, and he was managed nonsurgically with ventriculostomy for intracranial pressure control. Throughout his course in the neurosurgical intensive care unit, he displayed persistent left hemiparesis. INTERVENTION Further radiological and electrophysiological studies were undertaken in an attempt to explain his left hemiparesis. Brain magnetic resonance imaging demonstrated T2 prolongation in the central portion of the right cerebral peduncle extending to the right internal capsule. Electrophysiological studies using transcranial electrical motor evoked potentials revealed both a marked increase in voltage threshold, as well as a reduction in the complexity of the motor evoked potential waveform on the hemiparetic left side. This contrasted to significantly lower voltage threshold as well as a highly complex motor evoked potential waveform recorded on the relatively intact contralateral side. CONCLUSION This is the first time that clinical, radiological, and electrophysiological findings have been correlated in a case of Kernohan's notch syndrome. Compression of the contralateral cerebral peduncle against the tentorial incisura can lead to damage and ipsilateral hemiparesis. The anatomic extent of the lesion can be defined by magnetic resonance imaging and the physiological extent by electrophysiological techniques.

Intraoperative Motor Evoked Potential Alteration in Intracranial Tumor Surgery and Its Relation to Signal Alteration in Postoperative Magnetic Resonance Imaging

Neurosurgery ◽  
2010 ◽  
Vol 67 (2) ◽  
pp. 302-313 ◽  
Author(s):  
Andrea Szelényi ◽  
Elke Hattingen ◽  
Stefan Weidauer ◽  
Volker Seifert ◽  
Ulf Ziemann
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Motor Cortex ◽  
Evoked Potential ◽  
Corticospinal Tract ◽  
Motor Evoked Potential ◽  
Motor Deficit ◽  
Warning Sign ◽  
Precentral Gyrus ◽  
Resonance Imaging

Abstract OBJECTIVE To determine the degree to which the pattern of intraoperative isolated, unilateral alteration of motor evoked potential (MEP) in intracranial surgery was related to motor outcome and location of new postoperative signal alterations on magnetic resonance imaging (MRI). METHODS In 29 patients (age, 42.8 ± 18.2 years; 15 female patients; 25 supratentorial, 4 infratentorial procedures), intraoperative MEP alterations in isolation (without significant alteration in other evoked potential modalities) were classified as deterioration (> 50% amplitude decrease and/or motor threshold increase) or loss, respectively, or reversible and irreversible. Postoperative MRI was described for the location and type of new signal alteration. RESULTS New motor deficit was present in all 5 patients with irreversible MEP loss, in 7 of 10 patients with irreversible MEP deterioration, in 1 of 6 patients with reversible MEP loss, and in 0 of 8 patients with reversible MEP deterioration. Irreversible compared with reversible MEP alteration was significantly more often correlated with postoperative motor deficit (P < .0001). In 20 patients, 22 new signal alterations affected 29 various locations (precentral gyrus, n = 5; corticospinal tract, n = 19). Irreversible MEP alteration was more often associated with postoperative new signal alteration in MRI compared with reversible MEP alteration (P = .02). MEP loss was significantly more often associated with subcortically located new signal alteration (P = .006). MEP deterioration was significantly more often followed by new signal alterations located in the precentral gyrus (P = .04). CONCLUSION MEP loss bears a higher risk than MEP deterioration for postoperative motor deficit resulting from subcortical postoperative MR changes in the corticospinal tract. In contrast, MEP deterioration points to motor cortex lesion. Thus, even MEP deterioration should be considered a warning sign if surgery close to the motor cortex is performed.

Impact of a Carbohydrate Mouth Rinse on Quadriceps Muscle Function and Corticomotor Excitability

2019 ◽  
Vol 14 (7) ◽  
pp. 927-933 ◽  
Author(s):  
Stephen P. Bailey ◽  
Julie Hibbard ◽  
Darrin La Forge ◽  
Madison Mitchell ◽  
Bart Roelands ◽  
...  
Keyword(s):  
Evoked Potential ◽  
Motor Evoked Potential ◽  
Rectus Femoris ◽  
Quadriceps Muscle ◽  
Voluntary Contraction ◽  
Muscle Performance ◽  
Mouth Rinse ◽  
Motor Excitability ◽  
The Right ◽  
Relative Change

Background: Carbohydrate (CHO) mouth rinse (MR) before exercise has been shown to improve physical performance and corticospinal motor excitability. Purpose: To determine the effects of different forms of CHO MR on quadriceps muscle performance and corticospinal motor excitability. Methods: 10 subjects (5 female and 5 male; 25 [1] y, 1.71 [0.03] m, 73 [5] kg) completed 4 conditions (placebo [PLA], 6.4% glucose [GLU], 6.4% maltose [MAL], 6.4% maltodextrin [MDX]). Maximal voluntary contraction (MVIC) of the right quadriceps and motor-evoked potential (MEP) of the right rectus femoris was determined pre (10 min), immediately after, and post (10 min) 20-s MR. MEP was precipitated by transcranial magnetic stimulation during muscle contraction (50% MVIC). Results: The relative change in MEP from pre-measures was different across treatments (P = .025) but was not different across time (P = .357). MEP was greater for all CHO conditions immediately after (GLU = 2.58% [5.33%], MAL = 3.92% [3.90%], MDX = 18.28% [5.57%]) and 10 min after (GLU = 14.09% [13.96%], MAL = 8.64% [8.67%], MDX = 31.54% [12.77%]) MR than PLA (immediately after = −2.19% [4.25%], 10 min = −13.41% [7.46%]). MVC was greater for CHO conditions immediately (GLU = 3.98% [2.49%], MAL = 5.89% [2.29%], MDX = 7.66% [1.93%]) and 10 min after (GLU = 7.22% [2.77%], MAL = 10.26% [4.22%], MDX = 10.18% [1.50%]) MR than PLA (immediately after = −3.24% [1.50%], 10 min = −6.46% [2.22%]). Conclusions: CHO MR increased corticospinal motor excitability and quadriceps muscle after application. The form of CHO used did not influence this response.

Magnetic Resonance Imaging of Kernohan's Notch

Neurosurgery ◽  
1990 ◽  
Vol 27 (2) ◽  
pp. 205-207 ◽  
Author(s):  
Alan R. Cohen ◽  
John Wilson
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Nerve Palsy ◽  
Motor Deficit ◽  
Cerebral Peduncle ◽  
Resonance Imaging ◽  
Oculomotor Palsy ◽  
Extradural Hematoma ◽  
Tentorial Incisura ◽  
Supratentorial Mass

Abstract Compression of the cerebral peduncle against the tentorial incisura contralateral to a supratentorial mass, the so-called Kernohan's notch. can be a cause of false localizing motor signs. The authors present a case of Kernohan's notch secondary to a traumatic extradural hematoma. The patient developed an oculomotor palsy and a dense motor deficit ipsilateral to the extra-axial hematoma. Magnetic resonance imaging in the postoperative period clearly showed the midbrain lesion. The motor deficit and 3rd nerve palsy subsequently resolved.

scholarly journals Interhemispheric interactions between trunk muscle representations of the primary motor cortex

2017 ◽  
Vol 118 (3) ◽  
pp. 1488-1500 ◽  
Author(s):  
Loyda Jean-Charles ◽  
Jean-Francois Nepveu ◽  
Joan E. Deffeyes ◽  
Guillaume Elgbeili ◽  
Numa Dancause ◽  
...  
Keyword(s):  
Evoked Potential ◽  
Primary Motor Cortex ◽  
Motor Evoked Potential ◽  
Lumbar Vertebra ◽  
Arm Movement ◽  
Erector Spinae ◽  
Trunk Muscles ◽  
Interhemispheric Inhibition ◽  
Axial Muscles ◽  
The Right

Unilateral arm movements require trunk stabilization through bilateral contraction of axial muscles. Interhemispheric interactions between primary motor cortices (M1) could enable such coordinated contractions, but these mechanisms are largely unknown. Using transcranial magnetic stimulation (TMS), we characterized interhemispheric interactions between M1 representations of the trunk-stabilizing muscles erector spinae at the first lumbar vertebra (ES L1) during a right isometric shoulder flexion. These interactions were compared with those of the anterior deltoid (AD), the main agonist in this task, and the first dorsal interosseous (FDI). TMS over the right M1 elicited ipsilateral silent periods (iSP) in all three muscles on the right side. In ES L1, but not in AD or FDI, ipsilateral motor evoked potential (iMEP) could precede the iSP or replace it. iMEP amplitude was not significantly different whether ES L1 was used to stabilize the trunk or was voluntarily contracted. TMS at the cervicomedullary junction showed that the size of cervicomedullary evoked potential was unchanged during the iSP but increased during iMEP, suggesting that the iSP, but not the iMEP, is due to intracortical mechanisms. Using a dual-coil paradigm with two coils over the left and right M1, interhemispheric inhibition could be evoked at interstimulus intervals of 6 ms in ES L1 and 8 ms in AD and FDI. Together, these results suggest that interhemispheric inhibition is dominant when axial muscles are involved in a stabilizing task. The ipsilateral facilitation could be evoked by ipsilateral or subcortical pathways and could be used depending on the role axial muscles play in the task. NEW & NOTEWORTHY The mechanisms involved in the bilateral coordination of axial muscles during unilateral arm movement are poorly understood. We thus investigated the nature of interhemispheric interactions in axial muscles during arm motor tasks in healthy subjects. By combining different methodologies, we showed that trunk muscles receive both inhibitory and facilitatory cortical outputs during activation of arm muscles. We propose that inhibition may be conveyed mainly through interhemispheric mechanisms and facilitation by subcortical mechanisms or ipsilateral pathways.

Motor Evoked Potential Monitoring with Supratentorial Surgery

Neurosurgery ◽  
2004 ◽  
Vol 54 (5) ◽  
pp. 1061-1072 ◽  
Author(s):  
Georg Neuloh ◽  
Ulrich Pechstein ◽  
Cornelia Cedzich ◽  
Johannes Schramm
Keyword(s):  
Motor Function ◽  
High Frequency ◽  
Evoked Potential ◽  
Motor Evoked Potential ◽  
Electrode Placement ◽  
Motor Deficit ◽  
Clinical Value ◽  
Electrophysiological Findings ◽  
Muscle Groups ◽  
Evoked Potential Monitoring

ABSTRACT OBJECTIVE: To assess feasibility and clinical value of motor evoked potential (MEP) monitoring with surgery close to supratentorial motor areas and pathways. METHODS: Functional mapping by somatosensory evoked potential phase reversal and continuous MEP recording after high-frequency repetitive electrical cortex stimulation was performed during 182 operations in 177 patients. Significant MEP changes were reported to trigger surgical reaction. Intraoperative surgical and electrophysiological findings were documented prospectively. Patient files were reviewed for clinical data. MEP monitoring results were correlated with motor outcome. RESULTS: MEP recording was successful in 167 cases (91.8%). Inadequate electrode placement was an important reason for failed recording in the remaining patients, whereas preoperative paresis and anesthesia had no significant effect. Permanently disabling new motor deficit occurred in 8 cases (4.9%), whereas transient and non-disabling weakness was frequent (27.4%). Significant MEP changes occurred during 64 operations (39%). Irreversible MEP loss always predicted new, usually permanent, paresis. Unaltered MEP recordings indicated unimpaired motor function in the monitored muscle groups, except for rare transient deficit because of late edema and rebleeding. Irreversible MEP deterioration without loss and reversible changes could be associated with new paresis, which was transient in most patients. No major complications were observed, except for intraoperative generalized seizure in one epilepsy patient under insufficient anticonvulsant therapy. CONCLUSION: MEP monitoring with supratentorial surgery is feasible and safe. It may help to maximize resection within the limits of preserved motor function. Further evidence is needed to confirm these results.

scholarly journals Clinical Utility of Diffusion Tensor Imaging and Fibre Tractography for Evaluating Diffuse Axonal Injury with Hemiparesis

2013 ◽  
Vol 2013 ◽  
pp. 1-5 ◽  
Author(s):  
Ken Sugiyama ◽  
Takeo Kondo ◽  
Yoshimi Suzukamo ◽  
Yutaka Oouchida ◽  
Mari Sato ◽  
...  
Keyword(s):  
Diffusion Tensor Imaging ◽  
Diffusion Tensor ◽  
Imaging Techniques ◽  
Axonal Injury ◽  
Diffuse Axonal Injury ◽  
Cerebral Peduncle ◽  
Motor Disorders ◽  
Healthy Controls ◽  
Left Hemiparesis ◽  
The Right

Although diffuse axonal injury (DAI) frequently manifests as cognitive and/or motor disorders, abnormal brain findings are generally undetected by conventional imaging techniques. Here we report the case of a patient with DAI and hemiparesis. Although conventional MRI revealed no abnormalities, diffusion tensor imaging (DTI) and fibre tractography (FT) revealed the lesion speculated to be responsible for hemiparesis. A 37-year-old woman fell down the stairs, sustaining a traumatic injury to the head. Subsequently, she presented with mild cognitive disorders and left hemiparesis. DTI fractional anisotropy revealed changes in the right cerebral peduncle, the right posterior limb of the internal capsule, and the right corona radiata when compared with the corresponding structures observed on the patient’s left side and in healthy controls. On FT evaluation, the right corticospinal tract (CST) was poorly visualised as compared with the left CST as well as the CST in healthy controls. These findings were considered as evidence that the patient’s left hemiparesis stemmed from DAI-induced axonal damage in the right CST. Thus, DTI and FT represent useful techniques for the evaluation of patients with DAI and motor disorders.

scholarly journals Resection of an anterolateral mesencephalic cavernoma via transsylvian/transuncal approach in a child

2019 ◽  
Vol 1 (1) ◽  
pp. V23
Author(s):  
Sahin Hanalioglu ◽  
Omer Selcuk Sahin ◽  
Mehmet Erhan Turkoglu
Keyword(s):  
Temporal Lobe ◽  
Cavernous Malformation ◽  
Oculomotor Nerve ◽  
Gross Total Resection ◽  
Neurological Deficits ◽  
Cerebral Peduncle ◽  
Left Hemiparesis ◽  
Total Resection ◽  
The Right

This video demonstrates the resection of an anterolateral mesencephalic cavernous malformation (CM) through a transsylvian/transuncal approach. A 10-year-old girl presented with progressive headache and left-sided spastic hemiparesis. Neuroimaging revealed a 20-mm CM located in the right anterolateral midbrain/cerebral peduncle. After orbitozygomatic craniotomy and wide sylvian fissure opening, the oculomotor nerve was dissected and separated from the temporal lobe. Partial resection of the uncus allowed access to the CM through the oculomotor-tentorial triangle. The CM was excised in a piecemeal fashion. Postoperative imaging confirmed the gross-total resection. The patient had no additional neurological deficits postoperatively. Her left hemiparesis almost completely resolved at the 12-month follow-up.The video can be found here: https://youtu.be/Jb_EaWbn5LU.

scholarly journals Migrainous Infarction with Adjacent Cortical Enhancement

2021 ◽  
Vol 39 (3) ◽  
pp. 181-184
Author(s):  
In-Ho Yoon ◽  
Seung-Hoon Yun ◽  
Young-Mok Song
Keyword(s):  
Posterior Cerebral Artery ◽  
Brain Magnetic Resonance Imaging ◽  
Resonance Imaging ◽  
Left Hemiparesis ◽  
Diffusion Restriction ◽  
Blood Brain Barrier Disruption ◽  
Lingual Gyrus ◽  
Restricted Region ◽  
Brain Barrier Disruption ◽  
The Right

A 26-year old woman developed left homonymous superior quadrantanopia followed by severe pulsating headache with vomiting. Thereafter, she experienced recurrent left hemiparesis and paresthesia with or without headache. Brain magnetic resonance imaging showed diffusion restriction in the territory of the right posterior cerebral artery and contrast enhancement in the right lingual gyrus adjacent to the diffusion-restricted region. This case suggests an occurrence of cerebral infarction and blood-brain barrier disruption associated with migraine with aura.

Sign in / Sign up

Export Citation Format

Share Document