Ipsilateral hemiparesis is occasionally caused by a medullary lesion or by secondary damage to the cerebral peduncle contralateral to the lesion, a so-called Kernohan-Woltman notch phenomenon (KWNP). A possible mechanism of ipsilateral hemiparesis is that morphological changes in the brainstem associated with KWNP are accompanied by irreversible damage to the adjacent corticospinal tract (CST). A few reports dealing with the acute and sub-acute stages of this paradoxical phenomenon have appeared in the literature.
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