Brown-Sequard Syndrome

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Top Contributors - Cindy John-Chu, Kim Jackson, Hetvi Gala, Stacy Schiurring and Ahmed M Diab

Clinically Relevant Anatomy

Brown-Sequard Syndrome (BSS) is a neurological condition that results from a hemisection to the spinal cord. This lesion leads to interruption of normal function of nerve tracts in the one half of the spinal cord. It typically presents with paralysis on the side of the lesion due to compromise to the lateral corticospinal tracts; loss of proprioception and vibration sense on the same side from damage to the dorsal column and a loss of pain and temperature sensation contralateral to the lesion owing to injury to the lateral spinothalamic tract.

See the videos below to further understand the anatomy of the spinal cord in relation to BSS.

Mechanism of Injury / Pathological Process

The mechanism of injury in BSS can either be traumatic or non-traumatic with traumatic being more common.

Tramatic causes of BSS are as follows:

• Stab injury to the cervical region
• Gunshot wound to the spine
• Motor vehicular accident
• Fractured vertebra from a resultant fall
  

Non-traumatic mechanisms could include:

• Vertebral disc herniation
• Tumours
• Cervical spondylosis
• Multiple sclerosis
• Radiation
• Cystic disease

Clinical Presentation

BSS is characterized by:

• Ipsilateral lower motor neuron paralysis in the segment of the lesion.
• Contralateral loss of pain and temperature sensations below the level of the lesion.
• Ipsilateral loss of tactile discrimination, vibratory and proprioceptive sensations below the level of the lesion.
• Contralateral partial loss of tactile sensation below the level of the lesion.
• Ipsilateral spastic paralysis below the level of the lesion.
  

Diagnostic Procedures

• A detailed history should be taken to determine possible causes of the damage i.e. whether the lesion is traumatic or infectious. An extensive examination should be carried out to ascertain the extent of neurological damage and what deficits to expect, depending on the level of injury. This examination should involve a detailed motor and sensory evaluation.
• Laboratory tests should be carried out when infections are suspected.
• Diagnostic imaging especially, magnetic resonance imaging to ascertain the aetiology and level of cord hemisection.
  

Outcome Measures

The following outcome measures will be useful in the assessment and management of BSS.

• American Spinal Cord Injury Association (ASIA) Impairment Scale
• Functional Independence Measure (FIM)
• Spinal Cord Independence Measure (SCIM)

add links to outcome measures here (see Outcome Measures Database)

Management / Interventions

The management approach to choose for BSS is dependent on the underlying aetiology. The decision to opt for either conservative or surgical management depends on the patient's neurological and radiological findings.

Physiotherapy Management

Medical Management

Medical management is the treatment of choice where aetiology of BSS is either infective or demyelinating.

Surgical Management

Surgery is recommended in cases of trauma where cerebrospinal leakage, retention of foreign objects and signs of external cord compression are present.

• Decompressive surgery
• Spinal immobilization

add text here relating to management approaches to the condition

Differential Diagnosis

These should include:

• Stroke
• Multiple sclerosis
• Anterior cord syndrome
• Posterior cord syndrome
• Syringomyelia
  

Resources

add appropriate resources here

References