Brown-Séquard Syndrome: Symptoms, Causes, Treatment, Prognosis, Pathophysiology, Diagnosis
What is Brown-Séquard Syndrome?
Brown-Séquard Syndrome is a disorder due to incomplete spinal cord lesion where one half of the body may lose normal ability or may be paralyzed while the other half of the body loses its normal sensation. Brown-Séquard Syndrome is not common and is caused by any kind of injury to the spine in the area of the neck or back. In Brown-Séquard Syndrome, the affected person loses the sense of touch, vibrations and position in three dimensions below the level of the injury, which is called hemiparalysis. The loss of sensation is ipsilateral, while loss of sense of temperature and pain, which is known as hypalgesia in medical terminology, accompanies on the other side of the body (contralateral).
Symptoms of Brown-Séquard Syndrome
The following are the primary symptoms of Brown-Séquard Syndrome -
- First symptoms of Brown-Séquard syndrome are usually loss of sensation of pain, loss of sensation of temperature, which takes place often below the affected area and lead to loss of bowel and bladder control.
- Weakness and collapse (paralysis) of muscles below the affected area and on the same side (ipsilateral) of the affected area is also another symptom of Brown-Séquard Syndrome.
- Loss of sensation of vibration, soft touch and ability to understand position of an object are also lost on the opposite side of the wound in the spinal cord.
Prognosis of Brown-Séquard syndrome
The prognosis for individuals with Brown-Séquard Syndrome varies contingent on the cause of the disorder. Almost 90% of people suffering from Brown-Séquard Syndrome recover bladder & bowel control and over 80% regain the ability to walk at least partially.
Causes of Brown-Séquard Syndrome
The principle causes of Brown-Séquard Syndrome are as follows –
- In majority of cases, trauma is the primary cause of this syndrome. Brown-Séquard syndrome is observed following spinal cord injury caused by sharp1 or blunt trauma.
- Cysts or cystic diseases of spinal cord often cause Brown-Séquard syndrome. In some instances, it was detected that sudden pressure on an area of the spinal cord having undetected problems like cyst or tumor may lead to Brown-Séquard syndrome.
- Spinal cord tumor resulting in spinal cord syndrome may lead to Brown-Séquard syndrome.2
- Herniation of cervical or thoracic discs can cause Brown-Séquard syndrome.3
- Brown-Séquard Syndrome is also caused by spinal cord herniation.
- Multiple sclerosis, i.e. a disease in which the protective covering of the nerve cells is severely damaged can cause Brown-Séquard syndrome.
- Certain types of vascular diseases like ischemia and hemorrhage etc. may also cause Brown-Séquard syndrome.
- Certain types of infectious diseases like Tuberculosis, meningitis, empyema, herpes zoster virus, herpes simplex virus etc. are found to generate Brown-Séquard syndrome in some instances.
- Epidural hematoma in rare cases causes Brown-Séquard syndrome.4
Pathophysiology of Brown-Séquard Syndrome
A complete Brown-Séquard syndrome with hemi-section of the spinal cord seldom occurs. Hemi-section of the chord creates lesions on the following neural system –
- The Corticospinal Tract: It produces spastic paralysis on the same side of the body where lesion has occurred. The paralysis is normally detected below the lesion. At the level of the lesion, flaccid paralysis arises, which means the muscles lose their ability to move leading to weakness or paralysis of the adjoining parts.
- The Lateral Spinothalamic Tract: It leads to loss of pain and temperature sensations in the contralateral (opposite) side beginning one or two segments below the point of lesion.
- Posterior Columns: A lesion in the Gracile faciculus or the Tract of Goll leads to loss of sense of vibration, proprioception, and soft touch in the ipsilateral side. Same symptoms are detected in case of lesion in the Cuneate faciculus or the Tract of Burdach.
Diagnosis of Brown-Séquard Syndrome
Primarily, Brown-Séquard Syndrome is diagnosed by detecting motor paralysis on ipsilateral side of the injury and deficit in pain and temperature sensations on contralateral side of the injury. This observational diagnosis is followed by some image testing as given below -
- For injuries in bones or in case of blunt trauma, Spinal plain radiograph helps to detect the affected spots precisely.
- MRI scanning can detect the extent of the injury and MRI is particularly helpful when injuries are due to any non-traumatic causes.5
- In traumatic causes of spinal cord injury, MRI is used when neurological conditions are deteriorating.
- In case, MRI is contraindicating, CT myelography is used.5
Differential Diagnosis of Brown-Séquard Syndrome
In majority of situations, diagnosis of Brown-Séquard Syndrome is made on the basis of presenting history and scan reports. As most of the cases are caused by trauma, it is important to undertake differential diagnosis with respect to closely resembling diseases when there is no history of trauma. The differential diagnosis to be over-ruled for the diagnosis of this condition is –
Treatments of Brown-Séquard Syndrome
At the start of treatment for Brown-Séquard syndrome, a systematic assessment, including neurological investigation, is performed to establish the level of injury. There is no specific treatment procedure available for Brown-Séquard syndrome. Treatment gives attention on the underlying cause of the syndrome. Some drugs are applied that control motor neuron disorders. Devices that help to continue day-to-day activities such as hand splits, limb supports, or a wheelchair are used whenever necessary for patients suffering from Brown-Séquard Syndrome. Various other aids for the patients with a difficulty in breathing or swallowing are also applied. Other treatment for Brown-Séquard syndrome is symptomatic and supportive like the following ones -
- Cervical spine or dorsal spine mobilization is necessary, which is done through different therapies.
- Neck is kept at rest with the help of cervical collar.
- Depending on the diagnosis, some surgical interventions may be needed. Such surgical interventions may improve prognosis to a great extent.
It is known that partial spinal cord injury makes walking very problematic. Researchers these days are trying to estimate the consequence of treadmill speed on spinal cord function and walking performance.
Complications of Brown-Séquard Syndrome
Untreated Brown-Séquard syndrome may bring other complications like the following ones:
- Hypotension or spinal shock
- Pulmonary embolism (Blockage of an artery connected with the lungs)
- Infection in lungs and urine
Brown-Séquard syndrome is a rare condition that grows out of certain spinal cord injury. Such injury may be caused by any other diseases like tumor or cyst in the spinal cord or may be caused by an accident. It partially or completely paralyses one side of the body on the same side as the lesion in the spinal cord, while on the opposite side of the lesion the affected person loses sensation of temperature, sensation of vibration and capacity to understand the position of a body. Brown-Séquard syndrome needs perfect diagnosis through the study of symptoms, scan reports and differential diagnosis method. Early treatment cures many of the symptoms almost completely and enables the patient to lead a normal life once again. Physical therapy and rehabilitation is of utmost importance in this case.
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