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This exit point is close to the midline at the inter-peduncular fossa and just medial to the cerebral peduncles, two large nerve fibre pathways carrying axons from the motor cortices to neurons in the brainstem and spinal cord.
Kernohan and Woltman (1929) described this condition as an effect of compressive forces resulting in the midbrain being forced against the contralateral edge of the cerebral peduncle.
Compared with controls, TBI patients showed marked abnormalities in the middle cerebral peduncles, in cingulum bundles, and in the right orbitofrontal white matter - areas that have been predicted by computer simulations to sustain the most intense stresses in a blast.

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