Brown-Sequard Syndrome
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Clinically Relevant Anatomy[edit | edit source]
Brown-Sequard Syndrome (BSS), an incomplete spinal cord injury, is a neurological condition that results from a hemisection to the spinal cord[1]. This lesion leads to interruption of normal function of nerve tracts in the one half of the spinal cord[2]. 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[edit | edit source]
The mechanism of injury in BSS can either be traumatic or non-traumatic with traumatic being more common[1].
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[1]
Clinical Presentation[edit | edit source]
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[5].
- 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[edit | edit source]
- 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[edit | edit source]
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)
Management / Interventions[edit | edit source]
Management approaches to choose for BSS are dependent on the underlying aetiology. The decision to opt for either conservative or surgical management depends on the patient's neurological and radiological findings[2]. However, all forms of management are geared towards achieving independence in activities of daily living and overall quality of life[1].
Physiotherapy Management[edit | edit source]
The goals of physiotherapy in the management of BSS include:
- To maintain strength in neurologically intact muscles
- To maintain range of motion in all affected joints and to prevent damage in them
- To prevent damage to skin through proper positioning
- To maintain a clear airway
- To provide emotional support to patients and their relatives
- To achieve early mobilization to enhance ambulation either independently or with a device[6]
Medical Management[edit | edit source]
Medical management is the treatment of choice where aetiology of BSS is either infective or demyelinating[2]. It may include:
- Wound debridement and closure in the case of open an open injury
- Anti-tetanus prophylaxis
- Antibiotics[7][6]
- Analgesics
- Antispasmodics
- Laxatives[6]
Surgical Management[edit | edit source]
Surgery is recommended in cases of trauma where cerebrospinal leakage, retention of foreign objects and signs of external cord compression are present[2]. Surgical intervention may include:
- Decompressive surgery
- Spinal immobilization
Prognosis[edit | edit source]
Patients with BSS have been reported to have better outcomes of improvement when compared to those with other spinal cord syndromes[8][7].
Differential Diagnosis[edit | edit source]
These should include:
- Stroke
- Multiple sclerosis
- Anterior cord syndrome
- Posterior cord syndrome
- Syringomyelia [1]
Resources[edit | edit source]
References[edit | edit source]
- ↑ 1.0 1.1 1.2 1.3 1.4 Shams S, Arain A. Brown Sequard Syndrome. [Updated 2020 Sep 14]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing, 2021.
- ↑ 2.0 2.1 2.2 2.3 Ranga U, Aiyappan SK. Brown-Séquard syndrome. The Indian Journal of Medical Research 2014; 140(4): 572-573.
- ↑ Medcrine Medical. Brown-Sequard Syndrome causes, pathophysiology, symptoms, diagnosis and treatment. Available from: http://www.youtu.be/J4rvgSQibTs [last accessed 20/4/2021]
- ↑ Dr Matt & Mike. Brown Sequard Syndrome. Available from: http://www.youtu.be/tSkocizPFAA [last accessed 21/4/2021]
- ↑ Wright R, Simpson EP. Myelopathies. In: Rolak, AL editor. Neurology Secrets (Fifth Edition). Mosby 2010. p131-140.
- ↑ 6.0 6.1 6.2 Vandenakker-Albanese C, Brown-Sequard Syndrome [Internet]. 2020 [cited 20 May 2021]. Available from: https://emedicine.medscape.com/article/321652-overview
- ↑ 7.0 7.1 Toluse A, Adeyemi T, Angaye E, Alimi M. Brown-sequard syndrome: A case series from a regional hospital in Nigeria. Niger J Orthop Trauma 2020;19:77-9
- ↑ Mckinley W, Santos K, Meade M, Brooke K. Incidence and Outcomes of Spinal ord Injury Clinical Syndromes. The Journal of Spinal Cord Medicine 2007; 215-224.
- ↑ Neurology Analogy. Brown Sequard Syndrome/Animation/Explained Conceptually. Available from: https://youtu.be/WpjGmKnGv1c [last accessed 20/5/2021]
