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Brown-Séquard Syndrome

Classic presentations are uncommon, and often presents as asymmetrical hemiplegia and reduction of pain sensation that is more prominent on the less paretic side.

Overall, the condition is rare, making up 1-4% of all spinal cord injuries, and most commonly in the context of penetrating trauma. The cervical cord is the most common region affected. Rarely, occurs as a result of blunt trauma, disc herniations, fractures, tumours or haematoma...

Overall prognosis is good, and has the best functional outcome compared to other spinal cord injuries. However, the classic presentation of Brown-Séquard syndrome confers a worse prognosis.

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Articles of Interest

A Boring guide to Spinal Cord Syndromes

Brown-Sequard is a hemi-cord injury, typically noted in the setting of penetrating trauma. The patient will have injury to their dorsal column, corticospinal tract and spinothalamic tract – therefore causing ipsilateral loss of motor function, and proprioception/vibration. Since the spinothalamic tract crosses over, they will have contralateral loss of pain and temperature.

Brown-Séquard syndrome from herniation of a thoracic disc

In Brown-Séquard syndrome, the contralateral loss of sensation to sharp touch and temperature is attributable to the compression of the neurons in the spinothalamic tract, decussating near where they enter the spinal cord. Disruption of this ascending tract leads to sensory loss opposite to the compression. The ipsilateral weakness and loss of proprioception result from compression of the lateral corticospinal tract and posterior columns, respectively.

Cervical disc herniation causing Brown-Sequard syndrome

Brown-Sequard syndrome (BSS) is manifested as ipsilateral motor deficit and contralateral sensory loss. BSS caused by herniated cervical disc is extremely rare and easily be misdiagnosed, and clinical features of this problem were not fully understood.

Conservative Management of Traumatic Brown-Séquard Syndrome: A Case Report

Traumatic spinal cord injuries are quite common; however, a rare form of incomplete spinal cord injury is Brown-Séquard syndrome. Brown-Séquard syndrome is defined by the National Institute of Neurological Disorders and Strokes as “a rare neurological condition characterized by a lesion in the spinal cord which results in weakness or paralysis (hemiparaplegia) on one side of the body and a loss of sensation (hemianesthesia) on the opposite side.”

Traumatic Brown-Séquard syndrome

Stab injuries of the spine are rare, and usually inflicted from behind; most commonly they involve the cervical and upper dorsal spine and two-thirds of victims[2] show an incomplete cord injury with Brown-Séquard or Brown-Séquard-plus syndrome, less frequently intradural or epidural hematoma. Concurrent injuries can affect every organ.

Resources

Neuropedia

Brown-Sequard syndrome (BSS) is classified as an incomplete spinal cord injury, where sensory and motor functions are not completely lost below the level of damage. Brown-Sequard syndrome, named after the physiologist Charles-Edouard Brown-Séquard (1817–1894), was famous for his contributions to the fields of neurology and endocrinology. He first published this condition in (1849) and discussed it later on other occasions: one was a case about a sea captain who developed the syndrome after getting stabbed in the neck.

Physiopedia

Brown-Sequard Syndrome (BSS), an incomplete spinal cord injury, is a neurological condition that results from a hemisection to the spinal cord on either side, typically in the cervical and thoracic spinal cord region. This lesion leads to interruption of normal function of nerve tracts in one half of the spinal cord.

Radiopaedia

Due to some fibers crossing within the cord whilst others cross in the brainstem, the neurology is bilateral...

StatPearls

Famous Victorian scientist, Charles-Édouard Brown-Séquard, explained a rare spinal cord injury known as Brown-Séquard's syndrome (BSS) in 1849. He presented the case to the British Medical Association's annual meeting in 1862, which involved a sea captain who had been stabbed in the neck.