Brown-Séquard syndrome

Brown-Séquard syndrome (also known as Brown- of the medulla. Therefore, a hemi-section lesion of the
Séquard’s hemiplegia, Brown-Séquard’s paralysis, spinal cord will demonstrate loss of both fine touch (pre-
hemiparaplegic syndrome, hemiplegia et hemipara- served on the contralateral side) and crude touch (destruc-
plegia spinalis, or spinal hemiparaplegia) is caused by tion of the decussated spinothalamic fibers from the con-
damage to one half of the spinal cord, resulting in paral- tralateral side) on the ipsilateral side.
ysis and loss of proprioception on the same (or ipsilat- Pure Brown-Séquard syndrome is associated with the fol-
eral) side as the injury or lesion, and loss of pain and lowing:
temperature sensation on the opposite (or contralateral)
side as the lesion. It is named after physiologist Charles-
Édouard Brown-Séquard, who first described the condi- • Interruption of the lateral corticospinal tracts:
tion in 1850.[1]
• Ipsilateral spastic paralysis below the level of
the lesion
1 Classification • Babinski sign ipsilateral to lesion
• Abnormal reflexes and Babinski sign may not
Any presentation of spinal injury that is an incomplete le-
be present in acute injury.
sion (hemisection) can be called a partial Brown-Séquard
or incomplete Brown-Séquard syndrome.
• Interruption of posterior white column:
Brown-Séquard syndrome is characterized by loss of mo-
tor function (i.e. hemiparaplegia), loss of vibration sense • Ipsilateral loss of tactile discrimination, vibra-
and fine touch, loss of proprioception (position sense), tory, and position sensation below the level of
loss of two-point discrimination, and signs of weakness the lesion
on the ipsilateral (same side) of the spinal injury. This
is a result of a lesion affecting the dorsal column-medial
• Interruption of lateral spinothalamic tracts:
lemniscus tract, which carries fine (or light) touch fibers,
conscious proprioception, vibration, pressure and 2-point
discrimination, and the corticospinal tract, which carries • Contralateral loss of pain and temperature sen-
motor fibers. On the contralateral (opposite side) of the sation. This usually occurs 2-3 segments be-
lesion, there will be a loss of pain and temperature sen- low the level of the lesion.
sation and crude touch 1 or 2 segments below the level of
the lesion via the Spinothalamic Tract of the Anterolat-
eral System. Bilateral (both sides) ataxia may also occur
if the ventral spinocerebellar tract and dorsal spinocere-
2 Diagnosis
bellar tract are affected.
Magnetic resonance imaging (MRI) is the imaging of
choice in spinal cord lesions.
1.1 Fine (light) touch vs. crude (deep) Brown-Séquard syndrome is an incomplete spinal cord
touch lesion characterized by findings on clinical examination
which reflect hemisection of the spinal cord (cutting the
Crude touch, pain and temperature fibers are carried in spinal cord in half on one or the other side). It is diag-
the spinothalamic tract. These fibers decussate at the level nosed by finding motor (muscle) paralysis on the same
of the spinal cord. Therefore, a hemi-section lesion to the (ipsilateral) side as the lesion and deficits in pain and tem-
spinal cord will demonstrate loss of these modalities on perature sensation on the opposite (contralateral) side.
the contralateral side of the lesion, while preserving them This is called ipsilateral hemiplegia and contralateral pain
on the ipsilateral side. Upon touching this side, the pa- and temperature sensation deficits. The loss of sensation
tient will not be able to localize where they were touched, on the opposite side of the lesion is because the nerve
only that they were touched. This is because fine touch fibers of the spinothalamic tract (which carry information
fibers are carried in the dorsal column-medial lemniscus about pain and temperature) crossover once they meet the
pathway. The fibers in this pathway decussate at the level spinal cord from the peripheries.

1
2 6 EPIDEMIOLOGY

3 Causes

*
Brown-Séquard syndrome may be caused by a spinal
cord tumour, trauma [such as a gunshot wound or punc-
ture wound to the cervical (neck) or thoracic spine
(back)], ischemia (obstruction of a blood vessel), or in-
fectious or inflammatory diseases such as tuberculosis,
or multiple sclerosis. In its pure form, it is rarely seen.
The most common cause is penetrating trauma such
as a gunshot wound or stab wound to the spinal cord.
Decompression sickness may also be a cause of Brown-
1
Séquard syndrome.[2]
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 pro-
gression or resolution depends on the severity of the orig-
inal spinal cord injury and the underlying pathology that
caused it in the first place.

4 Pathophysiology
The hemisection of the cord results in a lesion of each of
the three main neural systems:
2 3
• the principal upper motor neuron pathway of the
corticospinal tract
• one or both dorsal columns
• the spinothalamic tract

As a result of the injury to these three main brain path-

ways the patient will present with three lesions: Brown-Séquard syndrome’s symptoms:
* = Side of the lesion
• The corticospinal lesion produces spastic paralysis 1 = hypotonic paralysis
on the same side of the body below the level of the 2 = spastic paralysis and loss of vibration and proprioception
(position sense) and fine touch
lesion (due to loss of moderation by the UMN). At
3 = loss of pain and temperature sensation
the level of the lesion, there will be flaccid paralysis
of the muscles supplied by the nerve of that level
(since Lower motor neurons are affected at the level
of the lesion). wound, there may be other life-threatening conditions
such as bleeding or major organ damage which should
• The lesion to fasciculus gracilis or fasciculus cunea- be dealt with on an emergent basis. If the syndrome is
tus results in ipsilateral loss of vibration and caused by a spinal fracture, this should be identified and
proprioception (position sense) as well as loss of all treated appropriately. Although steroids may be used to
sensation of fine touch. decrease cord swelling and inflammation, the usual ther-
apy for spinal cord injury is expectant.[3]
• The loss of the spinothalamic tract leads to pain and
temperature sensation being lost from the contralat-
eral side beginning one or two segments below the
lesion.
6 Epidemiology
5 Treatment Brown-Séquard syndrome is rare as the trauma would
have to be something that damaged the nerve fibres on
Treatment is directed at the pathology causing the paral- just one half of the spinal cord.[4] The classic cause is a
ysis. If it is because of trauma such as a gunshot or knife stab wound in the back.
 3

7 History into the neck”. Neurology. 60 (12): 2015–6.

doi:10.1212/01.wnl.0000068014.89207.99.
PMID 12821761.
Charles-Édouard Brown-Séquard studied the anatomy
and physiology of the spinal cord. He described this • Kraus JA, Stüper BK, Berlit P (1998). “Mul-
injury after observing spinal cord trauma which hap- tiple sclerosis presenting with a Brown-Séquard
pened to farmers while cutting sugar cane in Mauri- syndrome”. J. Neurol. Sci. 156 (1): 112–
3. doi:10.1016/S0022-510X(98)00016-1. PMID
tius. French physician, Paul Loye, attempted to confirm
9559998.
Brown-Séquard’s observations on the nervous system by
experimentation with decapitation of dogs and other ani- • Lim E, Wong YS, Lo YL, Lim SH (April 2003).
mals and recording the extent of each animal’s movement “Traumatic atypical Brown-Sequard syndrome:
case report and literature review”. Clin Neurol
after decapitation.[5]
Neurosurg. 105 (2): 143–5. doi:10.1016/S0303-
8467(03)00009-X. PMID 12691810.
• Lipper MH, Goldstein JH, Do HM (August 1998).
8 References “Brown-Séquard syndrome of the cervical spinal
cord after chiropractic manipulation”. AJNR Am
[1] C.-É. Brown-Séquard: De la transmission croisée des im- J Neuroradiol. 19 (7): 1349–52. PMID 9726481.
pressions sensitives par la moelle épinière. Comptes ren- • Mastronardi L, Ruggeri A (January 2004). “Cervi-
dus de la Société de biologie, (1850)1851, 2: 33-44. cal disc herniation producing Brown-Sequard syn-
drome: case report”. Spine. 29 (2): E28–
[2] Kimbro, T; Tom, T; Neuman, T (May 1997). “A case of
31. doi:10.1097/01.BRS.0000105984.62308.F6.
spinal cord decompression sickness presenting as partial
PMID 14722422.
Brown-Sequard syndrome.”. Neurology. 48 (5): 1454–6.
doi:10.1212/wnl.48.5.1454. PMID 9153492. • Miyake S, Tamaki N, Nagashima T, Kurata H,
Eguchi T, Kimura H (February 1998). “Idiopathic
[3] See: spinal cord herniation. Report of two cases and re-
view of the literature”. J. Neurosurg. 88 (2): 331–5.
• Egido Herrero JA, Saldanã C, Jiménez A, Vázquez doi:10.3171/jns.1998.88.2.0331. PMID 9452246.
A, Varela de Seijas E, Mata P (1992). “Spon-
taneous cervical epidural hematoma with Brown- • Rumana CS, Baskin DS (April 1996). “Brown-
Séquard syndrome and spontaneous resolution. Sequard syndrome produced by cervical disc her-
Case report”. J Neurosurg Sci. 36 (2): 117–9. niation: case report and literature review”. Surg
PMID 1469473. Neurol. 45 (4): 359–61. doi:10.1016/0090-
3019(95)00412-2. PMID 8607086.
• Ellger T, Schul C, Heindel W, Evers S, Ringel-
stein EB (June 2006). “Idiopathic spinal cord • Stephen AB, Stevens K, Craigen MA, Kerslake RW
herniation causing progressive Brown-Séquard syn- (October 1997). “Brown-Séquard syndrome due to
drome”. Clin Neurol Neurosurg. 108 (4): 388– traumatic brachial plexus root avulsion”. Injury. 28
91. doi:10.1016/j.clineuro.2004.07.005. PMID (8): 557–8. doi:10.1016/S0020-1383(97)83474-2.
16483712. PMID 9616398.

• Finelli PF, Leopold N, Tarras S (May 1992). [4] “Brown-Sequard Syndrome: Overview - eMedicine
“Brown-Sequard syndrome and herniated Emergency Medicine”.
cervical disc”. Spine. 17 (5): 598–600.
doi:10.1097/00007632-199205000-00022. [5] Loye, Paul (1889). “Death by Decapitation.”. The
PMID 1621163. American Journal of the Medical Sciences. 97 (4): 387.
doi:10.1097/00000441-188904000-00008. ISSN 0002-
• Hancock JB, Field EM, Gadam R (1997). “Spinal 9629.
epidural hematoma progressing to Brown-Sequard
syndrome: report of a case”. J Emerg Med. 15
(3): 309–12. doi:10.1016/S0736-4679(97)00010-
3. PMID 9258779. 9 External links
• Harris P (November 2005). “Stab wound of the
back causing an acute subdural haematoma and • Case studies of Brown-Séquard syndrome
a Brown-Sequard neurological syndrome”. Spinal
Cord. 43 (11): 678–9. doi:10.1038/sj.sc.3101765. • Image
PMID 15852056.
• Henderson SO, Hoffner RJ (1998). “Brown-
Sequard syndrome due to isolated blunt trauma”. J
Emerg Med. 16 (6): 847–50. doi:10.1016/S0736-
4679(98)00096-1. PMID 9848698.
• Hwang W, Ralph J, Marco E, Hemphill JC
(June 2003). “Incomplete Brown-Séquard
syndrome after methamphetamine injection
4 10 TEXT AND IMAGE SOURCES, CONTRIBUTORS, AND LICENSES

10 Text and image sources, contributors, and licenses

10.1 Text
• Brown-Séquard syndrome Source: https://en.wikipedia.org/wiki/Brown-S%C3%A9quard_syndrome?oldid=722121804 Contributors:
Rsabbatini, Gabbe, Jfdwolff, Rparle, Senca, CDN99, Arcadian, Anthony Appleyard, Axl, Sir Joseph, Rjwilmsi, Koavf, Stevenfruitsmaak,
Crystallina, SmackBot, Chris the speller, Losgann, Niels Olson, Sandiegosunseasurf, Sbmehta, Iridescent, BetacommandBot, Diogobruno,
Adamtunis, WhatamIdoing, Yobol, Tlj23, Captain Courageous, Garrondo, McM.bot, Guest9999, Wiae, BOTijo, Doc James, Rhcastilhos,
A E Francis, Bob1960evens, Addbot, LinkFA-Bot, Lightbot, OlEnglish, Filip em, Arbitrarily0, Legobot, Yobot, Citation bot, Jmarchn,
CXCV, FrescoBot, Citation bot 1, Angelito7, EmausBot, WikitanvirBot, Dcirovic, Helpful Pixie Bot, PhnomPencil, Neøn, Jdezwaan, Mr-
Bill3, PinkShinyRose, BattyBot, Koteessvar, ChrisGualtieri, TylerDurden8823, Esszet, Dexbot, Hardidave, CPTHAWK, Adam.i.daoud,
Praemonitus, Tchanders, AWes9, Martina Richard, Monkbot, Mjbailey, AlphaAntares and Anonymous: 53

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Original artist:
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