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Collier, however, was "unable to accept this explanation", his view being that since the sixth nerve emerges straight forward from the brain stem, whereas other cranial nerves emerge obliquely or transversely, it is more liable to the mechanical effects of backward brain stem displacement by intracranial space occupying lesions. [7]
Chronic subdural hematomas have been known to be a familiar cause of Kernohan's notch. [7] MRIs have shown evidence of Kernohan's notch from patients with traumatic head injury that are related to acute space-occupying lesions such as subdural hematoma, epidural hematoma, depressed skull fracture, or spontaneous intracerebral hematoma. [8] [9]
Space occupying lesions of the brain; Anatomical disorders of the spine such as scoliosis (although where pulmonary function is also impaired, spinal anaesthesia may be favored) [6] Hypovolaemia e.g. following massive haemorrhage, including in obstetric patients; Allergy; Relative Contraindication
Other secondary causes include space-occupying lesions, ankylosing spondylitis, rheumatoid arthritis, and Paget's disease. Less commonly, the cause of spinal stenosis may be present at birth as seen in achondroplasia, spina bifida, and certain mucopolysaccharidoses. [15]
Space-occupying lesions in the brain (abscesses, tumours) are one cause of unprovoked seizures. [3] In people with brain tumours, the frequency of epilepsy depends on the location of the tumor in the cortical region. [30] Abnormalities in blood vessels of the brain (Arteriovenous malformation) can also cause epilepsy. [3]
The symptoms will mimic those of space-occupying lesions. [7] Blood-borne spread certainly occurs, presumably by crossing the blood–brain barrier, but a proportion of patients may get TB meningitis from rupture of a cortical focus in the brain; [8] an even smaller proportion get it from rupture of a bony focus in the spine. [9]
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[4] [5] A space-occupying lesion, as the name suggests, has a recognizable volume and may impinge on nearby structures, whereas a non space-occupying lesion is simply a hole in the tissue, e.g. a small area of the brain that has turned to fluid following a stroke. [1] Lesions may also be classified by the shape they form.