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Brown-Sequard Syndrome or Brown-Séquard syndrome, also known as Brown-Séquard’s hemiplegia and Brown-Séquard’s paralysis, is a loss of motor function (paralysis and ataxia) and sensation caused by the lateral hemisection (cutting) of the spinal cord. Other synonyms are crossed hemiplegia, hemiparaplegic syndrome, hemiplegia et hemiparaplegia spinalis and spinal hemiparaplegia.
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.
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 Sequard 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 would 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 Sequard 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 which caused it in the first place.
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 there 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]
Any presentation of spinal injury which is an incomplete lesion can be called a partial Brown Sequard or incomplete Brown Sequard syndrome, so long as it has characterized by features of a motor loss on the same side of the spinal injury and loss of sensation on the opposite side.
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