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Brown-Sequard syndrome

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Brown-Séquard syndrome
ICD-10 G838
ICD-9 344.89
OMIM [1]
DiseasesDB 31117
MedlinePlus [2]
eMedicine emerg/70 pmr/17
MeSH {{{MeshNumber}}}

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. Other synonyms are crossed hemiplegia, hemiparaplegic syndrome, hemiplegia et hemiparaplegia spinalis and spinal hemiparaplegia.

ClassificationEdit

Any presentation of spinal injury that is an incomplete lesion can be called a partial Brown-Séquard or incomplete Brown-Séquard syndrome, so long as it has characterized by features of a motor loss on the same side of the spinal injury and loss of pain and temperature sensation on the opposite side.

DiagnosisEdit

Magnetic resonance imaging (MRI) is the imaging of choice in spinal cord lesions.

CausesEdit

Brown-Séquard syndrome may be caused by a spinal cord tumor, 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.

Brown-Séquard syndrome is an incomplete spinal cord lesion characterized by clinical presentation reflecting 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 side as the lesion and deficits in pain and temperature sensation on the opposite side on physical exam. This is called ipsilateral (on the same side as the spinal cord lesion) hemiplegia and contralateral (on the opposite side) pain and temperature sensation deficits. The loss of sensation on the opposite side of the lesion is because these nerve fibers of the spinothalamic tract cross the spinal cord. 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. Other causes are tumors, bleeding episodes, tuberculosis, and multiple sclerosis.

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.

PathophysiologyEdit

File:Brown-Sequard.svg

The hemisection of the cord results in a lesion of each of the three main neural systems:

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

  • The corticospinal lesion produces spastic paralysis on the same side of the body (the loss of moderation by the UMN).
  • The lesion to fasciculus gracilis or fasciculus cuneatus results in ipsilateral loss of vibration and proprioception (position sense).
  • The loss of the spinothalamic tract leads to pain and temperature sensation being lost from the contralateral side beginning one or two segments below the lesion.

TreatmentEdit

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.[1][2][3][4][5][6][7][8][9][10][11][12][13][14]

EpidemiologyEdit

Brown-Séquard syndrome is rare.[15]

HistoryEdit

The syndrome was first described in 1850 by the famed British / Mauritian neurologist Charles-Édouard Brown-Séquard (1817-1896), who studied the anatomy and physiology of the spinal cord. [16][17] Brown-Séquard was quite a controversial and eccentric figure, and is also known for self-reporting "rejuvenated sexual prowess after eating extracts of monkey testis". The response is now thought to have been a placebo effect, but apparently this was "sufficient to set the field of endocrinology off and running."[18]

Interestingly, many nations claim him as their own, he was the son of an American sea captain and a French woman. He was born in Mauritius. He studied in the US and France and worked several years in the UK, US and France. He described this injury after observing spinal cord trauma happen 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.[19][20]

ReferencesEdit

  1. Egido Herrero JA, Saldanã C, Jiménez A, Vázquez A, Varela de Seijas E, Mata P (1992). Spontaneous cervical epidural hematoma with Brown-Séquard syndrome and spontaneous resolution. Case report. J Neurosurg Sci 36 (2): 117–9.
  2. Ellger T, Schul C, Heindel W, Evers S, Ringelstein EB (June 2006). Idiopathic spinal cord herniation causing progressive Brown-Séquard syndrome. Clin Neurol Neurosurg 108 (4): 388–91.
  3. Finelli PF, Leopold N, Tarras S (May 1992). Brown-Sequard syndrome and herniated cervical disc. Spine 17 (5): 598–600.
  4. Hancock JB, Field EM, Gadam R (1997). Spinal epidural hematoma progressing to Brown-Sequard syndrome: report of a case. J Emerg Med 15 (3): 309–12.
  5. Harris P (November 2005). Stab wound of the back causing an acute subdural haematoma and a Brown-Sequard neurological syndrome. Spinal Cord 43 (11): 678–9.
  6. Henderson SO, Hoffner RJ (1998). Brown-Sequard syndrome due to isolated blunt trauma. J Emerg Med 16 (6): 847–50.
  7. Hwang W, Ralph J, Marco E, Hemphill JC (June 2003). Incomplete Brown-Séquard syndrome after methamphetamine injection into the neck. Neurology 60 (12): 2015–6.
  8. Kraus JA, Stüper BK, Berlit P (1998). Multiple sclerosis presenting with a Brown-Séquard syndrome. J. Neurol. Sci. 156 (1): 112–3.
  9. Lim E, Wong YS, Lo YL, Lim SH (April 2003). Traumatic atypical Brown-Sequard syndrome: case report and literature review. Clin Neurol Neurosurg 105 (2): 143–5.
  10. Lipper MH, Goldstein JH, Do HM (August 1998). Brown-Séquard syndrome of the cervical spinal cord after chiropractic manipulation. AJNR Am J Neuroradiol 19 (7): 1349–52.
  11. Mastronardi L, Ruggeri A (January 2004). Cervical disc herniation producing Brown-Sequard syndrome: case report. Spine 29 (2): E28–31.
  12. Miyake S, Tamaki N, Nagashima T, Kurata H, Eguchi T, Kimura H (February 1998). Idiopathic spinal cord herniation. Report of two cases and review of the literature. J. Neurosurg. 88 (2): 331–5.
  13. Rumana CS, Baskin DS (April 1996). Brown-Sequard syndrome produced by cervical disc herniation: case report and literature review. Surg Neurol 45 (4): 359–61.
  14. Stephen AB, Stevens K, Craigen MA, Kerslake RW (October 1997). Brown-Séquard syndrome due to traumatic brachial plexus root avulsion. Injury 28 (8): 557–8.
  15. Brown-Sequard Syndrome: Overview - eMedicine Emergency Medicine.
  16. Who Named It synd/973
  17. 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.
  18. The Practice of Neuroscience, p. 199-200, John C.M. Brust (2000).
  19. (1889). Loye: Death by Decapitation. The American Journal of the Medical Sciences 97.
  20. Alex Boese (2007). Elephants on Acid: And Other Bizarre Experiments, Houghton Mifflin Harcourt. URL accessed 2009-08-05.

External linksEdit


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