Brown-Séquard syndrome

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Brown-Séquard syndrome
Other namesBrown-Séquard's paralysis
SpecialtyNeurology Edit this on Wikidata

Brown-Séquard syndrome (also known as Brown-Séquard's hemiplegia, Brown-Séquard's paralysis, hemiparaplegic syndrome, hemiplegia et hemiparaplegia spinalis, or spinal hemiparaplegia) is caused by damage to one half of the spinal cord, i.e. hemisection of the spinal cord resulting in paralysis and loss of proprioception on the same (or ipsilateral) side as the injury or lesion, and loss of pain and temperature sensation on the opposite (or contralateral) side as the lesion. It is named after physiologist Charles-Édouard Brown-Séquard, who first described the condition in 1850.[1]

Causes

Brown-Séquard syndrome may be caused by injury to the spinal cord resulting from a spinal cord

tumor, trauma (such as a fall or injury from gunshot or puncture to the cervical or thoracic spine), 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. The most common cause is penetrating trauma such as a gunshot wound or stab wound to the spinal cord.[citation needed] Decompression sickness may also be a cause of Brown-Séquard syndrome.[2]

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.[citation needed]

Pathophysiology

Lesion on the patient's right
  1. loss of all sensation, hypotonic paralysis
  2. spastic paralysis and loss of vibration and proprioception (position sense) and fine touch
  3. loss of pain and temperature sensation

The hemisection of the cord results in a lesion of each of the three main neural systems:[citation needed]

As a result of the injury to these three main brain pathways the patient will present with three lesions:

In addition, if the lesion occurs above T1 of the spinal cord it will produce ipsilateral Horner's syndrome with involvement of the oculosympathetic pathway.

Diagnosis

Magnetic resonance imaging (MRI) is the imaging of choice in spinal cord lesions.[citation needed]

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.[citation needed]

Classification

Any presentation of spinal injury that is an incomplete lesion (hemisection) can be called a partial Brown-Séquard or incomplete Brown-Séquard syndrome.[citation needed]

Brown-Séquard syndrome is characterized by loss of motor function (i.e. hemiparaplegia), loss of vibration sense and fine touch, loss of

dorsal spinocerebellar tract are affected.[citation needed
]

Crude touch, pain and temperature fibers are carried in the

dorsal column-medial lemniscus pathway. The fibers in this pathway decussate at the level of the medulla. Therefore, a hemi-section lesion of the spinal cord will demonstrate loss of fine touch on ipsilateral side (preserved on the contralateral side) and crude touch (destruction of the decussated spinothalamic fibers from the contralateral side) on the contralateral side.[citation needed
]

Pure Brown-Séquard syndrome is associated with the following:[citation needed]

  • Interruption of the lateral corticospinal tracts:
    • Ipsilateral
      spastic paralysis
      below the level of the lesion
    • Babinski sign
      ipsilateral to lesion
    • Abnormal reflexes and Babinski sign may not be present in acute injury
  • Interruption of posterior white column:
    • Ipsilateral loss of tactile discrimination, vibratory, and position sensation below the level of the lesion
  • Interruption of lateral spinothalamic tracts:
    • Contralateral loss of pain and temperature sensation. This usually occurs 2–3 segments below the level of the lesion.

Treatment

Treatment is directed at the pathology causing the paralysis. 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.[citation needed]

Epidemiology

Brown-Séquard syndrome is rare as the trauma would have to be something that damaged the nerve fibres on just one half of the spinal cord.[3]

History

Charles-Édouard Brown-Séquard studied the anatomy and physiology of the spinal cord. He described this injury after observing spinal cord trauma which happened to farmers while cutting sugar cane in Mauritius. French physician, Paul Loye, attempted to confirm Brown-Séquard's observations on the nervous system by experimentation with decapitation of dogs and other animals and recording the extent of each animal's movement after decapitation.[4]

Notes

  1. ^ C.-É. Brown-Séquard: De la transmission croisée des impressions sensitives par la moelle épinière. Comptes rendus de la Société de biologie, (1850) 1851, 2: 33–44.
  2. S2CID 26978471
    .
  3. ^ "Brown-Sequard Syndrome: Overview – eMedicine Emergency Medicine". 2018-09-21. {{cite journal}}: Cite journal requires |journal= (help)
  4. ISSN 0002-9629
    .

Sources

External links

Wikimedia Commons has media related to Brown-Séquard syndrome.
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