5. Brown-Sequard syndrome

Question 1

Characteristics

Answer 1

Lat. hemisection of spinal. Rarely complete hemisection

Question 2

Signs and symptoms

Answer 2

Ipsilaterally:

• Hemiparaplegia (loss of motor function)
• % vibration, fine touch, proprioception (conscious & unconscious), two-point discrimination

Contralaterally:
- % pain, temp. & crude touch 1-2 segments below lesions

Question 3

Causes

Answer 3

Spinal cord tumor or tumor near by spinal cord
Trauma (knife stab)
Infections or infl. diseases (TB, MS)

Question 4

DDx

Answer 4

MS, Guillan-Barre syndrome

Question 5

Physical examination & diagnostic procedure

Answer 5

Asymmetrical paresis
Hypalgesia stronger on less paretic side
X-ray, MRI/CT

• Lat. corticospinal tract: Ipsilateral spastic paralysis below the level. UMN signs => increased tone, hyperreflexia, clonus & Hoffmann’s sign on one side of the body
• Pos. white column: Ipsilateral % tactile discimination, loss of vibration & position below the level
• Lat. spinothalamic tract: Contralateral % pain & temp. 1-2 segments below the level

Question 6

Treatment

Answer 6

Pharmacologic: Secondary effects; for spasticity, pain

• Nasogastric tube
• Cervical spine immobilization
• Dorsal vertebra immobilization

In general pat. regain function, thus no needed long-term medication