Brown-Séquard syndrome

Background

Spinal cord tracts

• Transverse hemisection of spinal cord
• Unilateral cord compression

Clinical Features

• Decussation of corticospinal tract at the medulla and complete lack of decussation of fibers of the posterior columns result in:
  • Ipsilateral spastic paresis
  • Ipsilateral loss of proprioception, vibration
• Decussation of anterolateral fibers within spinal tract one level up via anterior white commissure results in:
  • Contralateral loss of pain, temperature (ie 'sensory dissociation')

Differential Diagnosis

Spinal Cord Syndromes

• Complete spinal cord transection syndrome
• Anterior cord syndrome
• Central cord syndrome
• Brown-Sequard syndrome
• Epidural compression syndromes
  • Syringomyelia
  • Spinal cord compression (non-traumatic)
  • Cauda equina syndrome
  • Conus medullaris syndrome
  • Epidural abscess (spinal)
  • Epidural hematoma (spinal)

Evaluation

• Clinical presentation and mechanism

Management

• Consider intubation injuries at C5 or above
• Consider surgical intervention for:
  • Progressive neurologic deficits
  • Unstable spine fractures
• Steroids are no longer recommended
  • Administration of methylprednisolone (MP) for the treatment of acute spinal cord injury (SCI) is not recommended. Clinicians considering MP therapy should bear in mind that the drug is not Food and Drug Administration (FDA) approved for this application. There is no Class I or Class II medical evidence supporting the clinical benefit of MP in the treatment of acute SCI. Scattered reports of Class III evidence claim inconsistent effects likely related to random chance or selection bias. However, Class I, II, and III evidence exists that high-dose steroids are associated with harmful side effects including death.
  • See EBQ:High Dose Steroids in Cord Injury for further discussion

Prognosis

• Good

Disposition

• Admission

See Also

• Spinal cord syndromes

Authors:

Claire, Kevin Lu