Brown Séquard Syndrome

Definition

Definition of Brown Séquard Syndrome
Brown-Séquard syndrome, also known as Brown-Séquard's hemiplegia and Brown-Séquard's paralysis, is a loss of sensation and motor function (paralysis and ataxia) that is caused by the lateral hemisection (cutting) of the spinal cord.

Symptoms

Symptoms of Brown Séquard Syndrome
The list of signs and symptoms for Brown-Sequard Syndrome listed below:

1. Hemiparaplegia
2. Hemianesthesia - on the opposite side to the paralysis
3. Paralysis of voluntary muscles below level of lesion
4. Segmental atrophy at level of lesion
5. Sensory loss at level of lesion
6. Contralateral analgesia below lesion
7. Thermanesthesia below lesion
8. Sphincteral disturbances
9. Increased muscle tone at side of lesion
10. Increased deep reflexes
11. Clonus
12. Babinski sign

Causes

Causes of Brown Séquard Syndrome
Brown-Séquard syndrome may be caused by a spinal cord tumour, trauma (such as a gunshot wound or puncture wound to the neck or back), ischemia (obstruction of a blood vessel), or infectious or inflammatory diseases such as tuberculosis, or multiple sclerosis. In its pure form, it is rarely seen. Incomplete forms are also observed. The most common cause is penetrating trauma such as a gunshot wound or stab wound to the spinal cord. This may be seen most often in the cervical (neck) or thoracic spine.

The presentation can be progressive and incomplete. It can advance from a typical Brown-Séquard syndrome to complete paralysis. It is not always permanent, and progression or resolution depends on the severity of the original spinal cord injury and the underlying pathology that caused it in the first place.

Diagnosis

Diagnosis of Brown Séquard Syndrome
Magnetic resonance imaging (MRI) is the imaging of choice in spinal cord lesions.

Brown-Séquard syndrome is an incomplete spinal cord lesion characterized by findings on clinical examination which reflect hemisection of the spinal cord (cutting the spinal cord in half on one or the other side). It is diagnosed by finding motor (muscle) paralysis on the same (ipsilateral) side as the lesion and deficits in pain and temperature sensation on the opposite (contralateral) side. This is called ipsilateral hemiplegia and contralateral pain and temperature sensation deficits. The loss of sensation on the opposite side of the lesion is because the nerve fibers of the spinothalamic tract (which carry information about pain and temperature) crossover once they meet the spinal cord from the peripheries.

Treatment

Treatment of Brown Séquard Syndrome
Treatment is directed at the pathology causing the paralysis. If it is because of trauma such as a gunshot or knife wound, there may be other life threatening conditions such as bleeding or major organ damage which should be dealt with on an emergent basis. If the syndrome is caused by a spinal fracture, this should be identified and treated appropriately. Although steroids may be used to decrease cord swelling and inflammation, the usual therapy for spinal cord injury is expectant.

Prognosis

Prognosis of Brown Séquard Syndrome
The prognosis for individuals with BSS varies depending on the cause of the disorder.

Prevention

Prevention of Brown Séquard Syndrome
Consult with your doctor.