Brown-Séquard syndrome

A neurological condition resulting from hemisection of the spinal cord

Diagram illustrating the effects of Brown-Séquard syndrome

Brown-Séquard syndrome is a rare neurological condition characterized by a lesion in the spinal cord which results in weakness or paralysis (hemiparaplegia) on one side of the body and a loss of sensation (hemianesthesia) on the opposite side. This condition is named after the physiologist Charles-Édouard Brown-Séquard, who first described it in the 19th century.

Pathophysiology

Brown-Séquard syndrome occurs due to damage to one half of the spinal cord, typically as a result of trauma, such as a stab wound or a gunshot injury. The syndrome can also arise from other causes, including spinal cord tumors, ischemia, or infectious or inflammatory diseases affecting the spinal cord.

The hallmark of Brown-Séquard syndrome is the dissociation of motor and sensory deficits. The damage to the corticospinal tract on the affected side leads to ipsilateral motor weakness or paralysis. Meanwhile, the damage to the dorsal columns results in ipsilateral loss of proprioception and vibratory sensation. On the contralateral side, damage to the spinothalamic tract causes loss of pain and temperature sensation.

Clinical Presentation

Patients with Brown-Séquard syndrome typically present with:

• Ipsilateral spastic paralysis below the level of the lesion due to corticospinal tract involvement.
• Ipsilateral loss of proprioception and vibratory sense due to dorsal column involvement.
• Contralateral loss of pain and temperature sensation due to spinothalamic tract involvement.

Diagnosis

The diagnosis of Brown-Séquard syndrome is primarily clinical, based on the characteristic pattern of neurological deficits. Imaging studies, such as magnetic resonance imaging (MRI) or computed tomography (CT) scans, are used to identify the underlying cause of the spinal cord lesion and to assess the extent of the damage.

Treatment

Treatment of Brown-Séquard syndrome focuses on addressing the underlying cause of the spinal cord injury. In cases of trauma, surgical intervention may be necessary to stabilize the spine and decompress the spinal cord. Rehabilitation, including physical and occupational therapy, is crucial for maximizing functional recovery and improving quality of life.

Prognosis

The prognosis for individuals with Brown-Séquard syndrome varies depending on the cause and severity of the spinal cord injury. Some patients may experience significant recovery of motor and sensory function, while others may have persistent deficits. Early intervention and rehabilitation are key factors in improving outcomes.

Related pages

• Spinal cord injury
• Neurology
• Charles-Édouard Brown-Séquard

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