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Brown-Séquard syndrome

 

 
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Brown-Séquard syndrome
 
 
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Brown-Séquard syndrome, also known as Brown-Séquard's hemiplegia and Brown-Séquard's paralysis, is a loss of sensation and motor function (paralysis
Paralysis

Paralysis is the complete loss of muscle function for one or more muscle groups. Paralysis can cause loss of feeling or loss of mobility in the affected area....
 and ataxia
Ataxia

Ataxia is a neurology sign and symptom consisting of gross lack of coordination of muscle movements. Ataxia is a non-specific clinical manifestation implying dysfunction of parts of the nervous system that coordinate movement, such as the cerebellum....
) that is caused by the lateral hemisection (cutting) of the spinal cord
Spinal cord

The spinal cord is a long, thin, tubular bundle of neuron and glia that extends from the brain. The brain and spinal cord together make up the central nervous system....
. Other synonyms are crossed hemiplegia
Hemiplegia

Hemiplegia is a condition in which one-half of a patient's body is paralysis. Hemiplegia is more severe than hemiparesis, wherein one half of the body is weakened but not paralysed....
, hemiparaplegic syndrome, hemiplegia et hemiparaplegia spinalis and spinal hemiparaplegia.

presentation of spinal injury which is an incomplete lesion can be called a partial Brown-Séquard or incomplete Brown-Séquard 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.

etic resonance imaging (MRI) is the imaging of choice in spinal cord lesions.

n-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-Séquard 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).






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Encyclopedia


Brown-Séquard syndrome, also known as Brown-Séquard's hemiplegia and Brown-Séquard's paralysis, is a loss of sensation and motor function (paralysis
Paralysis

Paralysis is the complete loss of muscle function for one or more muscle groups. Paralysis can cause loss of feeling or loss of mobility in the affected area....
 and ataxia
Ataxia

Ataxia is a neurology sign and symptom consisting of gross lack of coordination of muscle movements. Ataxia is a non-specific clinical manifestation implying dysfunction of parts of the nervous system that coordinate movement, such as the cerebellum....
) that is caused by the lateral hemisection (cutting) of the spinal cord
Spinal cord

The spinal cord is a long, thin, tubular bundle of neuron and glia that extends from the brain. The brain and spinal cord together make up the central nervous system....
. Other synonyms are crossed hemiplegia
Hemiplegia

Hemiplegia is a condition in which one-half of a patient's body is paralysis. Hemiplegia is more severe than hemiparesis, wherein one half of the body is weakened but not paralysed....
, hemiparaplegic syndrome, hemiplegia et hemiparaplegia spinalis and spinal hemiparaplegia.

Classification

Any presentation of spinal injury which is an incomplete lesion can be called a partial Brown-Séquard or incomplete Brown-Séquard 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.

Diagnosis

Magnetic resonance imaging (MRI) is the imaging of choice in spinal cord lesions.

Causes

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-Séquard 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-Séquard 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.

Pathophysiology

The hemisection of the cord results in a lesion of each of the three main neural systems:
  • the principal upper motor neuron
    Upper motor neuron

    Upper motor neurons are motor neurons that originate in the Motor cortex of the cerebral cortex or the brain stem and carry motor information down to the final common pathway, that is, any motor neurons that are not directly responsible for stimulating the target muscle....
     pathway of the corticospinal tract
    Corticospinal tract

    The corticospinal or pyramidal tract is a collection of axons that travel between the cerebral cortex of the brain and the spinal cord.The corticospinal tract mostly contains motor axons....
  • one or both dorsal columns
  • the spinothalamic tract
    Spinothalamic tract

    The spinothalamic tract is a sensory pathway originating in the spinal cord. It transmits information to the thalamus about pain, temperature, itch and crude tactition....


As a result of the injury to these three main brain pathways the patient will present with three lesions.

  • The corticospinal lesion produces spastic paralysis on the same side of the body (the loss of moderation by the UMN
    Upper motor neuron

    Upper motor neurons are motor neurons that originate in the Motor cortex of the cerebral cortex or the brain stem and carry motor information down to the final common pathway, that is, any motor neurons that are not directly responsible for stimulating the target muscle....
    ).
  • The lesion to fasciculus gracilis
    Fasciculus gracilis

    The fasciculus gracilis is a bundle of axon fibres in the dorsomedial spinal cord that carries information about fine touch, vibrations, and conscious proprioception from the lower part of the body to the brain stem....
     or fasciculus cuneatus
    Fasciculus cuneatus

    The fasciculus cuneatus is a bundle of nerves in the spinal cord which primarily transmits information from the arms. It is part of the posterior column-medial lemniscus pathway....
     results in ipsilateral loss of vibration and proprioception
    Proprioception

    Proprioception ; from Latin proprius, meaning "one's own" and perception) is the sense of the relative position of neighbouring parts of the body....
     (position sense).
  • The loss of the spinothalamic tract leads to pain and temperature sensation being lost from the contralateral side beginning one or two segments below the lesion.


Treatment

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.

Epidemiology

Brown-Séquard syndrome is rare.

History

The syndrome was first described in 1850 by the famed British / Mauritian
Mauritian

Mauritian may refer to:* Something of, from, or related to Mauritius, an island nation off the coast of the African continent in the southwest Indian Ocean, about 900 kilometres east of Madagascar....
 neurologist Charles-Édouard Brown-Séquard
Charles-Édouard Brown-Séquard

Charles-?douard Brown-S?quard , Mauritius physiologist and neurologist, was born at Port Louis, Mauritius, on the April 8 1817. His father was an American and his mother a Frenchwoman, but he himself always desired to be looked upon as a British subject....
 (1817-1896), who studied the anatomy and physiology of the spinal cord. Brown-Séquard was quite a controversial and eccentric figure, and is also known for self-reporting "rejuvenated sexual prowess after eating extracts of monkey testis". The response is now thought to have been a placebo effect, but apparently this was "sufficient to set the field of endocrinology
Endocrinology

Endocrinology is a branch of medicine dealing with disorder of the endocrine system and its specific secretions called hormones....
 off and running."

Interestingly, many nations claim him as their own, he was the son of an American sea captain and a French woman. He was born in Mauritius
Mauritius

Mauritius , officially the Republic of Mauritius, , is an island nation off the coast of the African continent in the southwest Indian Ocean, about 900 kilometres east of Madagascar....
. He studied in the US and France and worked several years in the UK, US and France. He described this injury after observing spinal cord trauma happen to farmers while cutting sugar cane in Mauritius
Mauritius

Mauritius , officially the Republic of Mauritius, , is an island nation off the coast of the African continent in the southwest Indian Ocean, about 900 kilometres east of Madagascar....
.

External links

  • at ufl.edu