Brown Sequard Syndrome
• Damage to the half of spinal cord
• Due to stabbing wound, fracture , gunshot wound (penetrating trauma)
• ischemia / Infarction
• Spinal tumor ( mainly metastatic )
• Mostly have incomplete damage to the half of the spinal code. Hardly
seen completely half damage
Dorsal column
Fine touch
Ipsilateral : Dorsal column ( sensory )
corticospinal ( motor)
Contralateral : Spinothalamic ( sensory )
Vibrations
Proprioception
2 point discrimination
Spinothalamic Tract
l
Lateral column
Pain & Temperature
Anterior Column
Crude touch
Tickle
Itch
A way to get a clear clean half cut ( complete damage ) is through a bullet
or knife to the back.
Other Predisposing factors : Stroke ( can cause infarction )
MS
Clinical Presentation
One Sided motor loss
One sided ne touch, Vibratory, Proprioception sensation loss
Opposite side pain, Temperature & crude touch loss
Ipsilateral
• Loss of all sensations at the level of the lesion
• Loss of proprioception, vibration, and ne touch discrimination below the
level of the lesion
• Spastic paralysis (inability of voluntary muscle movement with increased
muscle tone ) below the level of the lesion
• Ipsilateral Babinski sign
due to the damage to
upper motor neuron
axons in the lateral
corticospinal tracts
• In lesions above T1, Horner
syndrome occurs.
due to damage to ipsilateral
sympathetic bers (the
oculosympathetic pathway)
• Segmental accid paresis (weakness) at the level of the lesion
(due to the damage to lower motor neurons at the level of the lesion)
Contra lateral
Loss of pain, temperature, & crude touch sensation one or two levels below
lesion due to an interrupted spinothalamic tract
Diagnosis
1.Clinical Diagnosis
• The identi cation of a disease or condition based on the patient's medical
history and Physical exam ndings.
While laboratory values or imaging studies may be obtained to con rm a
clinical diagnosis, they are not required.
2.Consider CT if trauma has occurred or an MRI if a tumor is suspected.
MRI is the best diagnostic step if we are not sure & trauma is already ruled
out
Treatment
Depends upon the underlying cause
• For non penetrating spinal injury steroids are used, Since it reduces the
swelling causing the lesion (methyl prednisolone)
• For penetrating injuries surgical management