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Brown-Sequard Syndrome is most commonly caused by penetrating trauma to the spinal cord. The case of a 15-year-old male who developed Brown-Sequard Syndrome following blunt cervical spine trauma sustained in an automobile accident is presented. Brown-Sequard Syndrome is rarely seen following blunt trauma; however, one must be suspicious so as not to overlook this type of lesion.
The authors report a new case of extra-dural hematoma of the spinal cord due to anticoagulants causing a clinical Brown-Sequard syndrome. Spontaneous recovery, which was almost complete, appears quite exceptional.
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Brown-Sequard syndrome (BSS) and Brown-Sequard-plus syndrome (BSPS) are characterised by asymmetrical paresis with hypalgesia more marked on the less paretic side. This study examined the clinical features of 38 patients (30 males and 8 females; mean age = 32 years) with traumatic cervical BSS or BSPS who underwent comprehensive inpatient rehabilitation. Twenty two injuries were caused by road traffic accidents, 8 by penetrating injuries, 5 by diving injuries, and 3 by other causes. After an average of 35 days in acute care and 79 days in rehabilitation, 37 patients had increased muscle strength, all 38 patients improved functional abilities, 29 patients walked independently, 34 had spontaneous bladder emptying, 36 were discharged home, and 14 were employed. Statistically significant increases (p less than 0.001) were made in modified Barthel index functional scores between admission and discharge. Patients with BSPS had a better prognosis than did those with 'pure' BSS. Patients with predominant upper limb weakness had more favourable outcomes than did those with predominant lower limb weakness. Few other potentially predictive demographic, injury, or neurological factors were associated with functional outcome. Patients with BSS or BSPS generally have a good prognosis for neurological and functional improvement.
A retrospective review of 17 immature patients who underwent posterior spinal fusion of C1-C2 or C1-C3 was performed to establish the efficacy of the procedure, to determine the incidence of complications, and to identify those at high risk for complications. All had radiographic C1-C2 instability or dislocation. Etiologies included os odontoideum, fixed rotatory subluxation, atlantoaxial subluxation, type II dens fracture nonunion, and nonunion of a Hangman's fracture. Before surgery, 10 patients were neurologically intact, and seven had neurologic findings. Associated diagnosis included Down's syndrome in three and Ehler-Danhlos in one. Follow-up averaged 25 months. One neurologically intact patient had a C2 radiculopathy that resolved by 1 year. Three patients with Down's syndrome had complications: one with a preoperative Brown-Sequard syndrome had transient worsening in the immediate postoperative period, one with a preoperative myelopathy developed a late recurrence of a severe myelopathy that required odontectomy, and another sustained an intraoperative spinal cord contusion followed by postoperative quadriplegia and death due to respiratory failure. Of seven reporting neurologic symptoms before surgery, two had residual deficit in the late postoperative period. These two represented preventable technical errors. There were two nonunions, one of which required occiput to C2 fusion. In general, posterior spinal fusion of the upper cervical spine was found to be a reliable, safe, and predictable procedure, but extra caution should be employed when considering arthrodesis in patients with ongoing spinal cord compression, fixed dislocations, and inherited ligamentous laxity.
Nine cases of multiple sclerosis with paroxysmal disorders were treated with acetazolamide. In most cases a brain-stem origin of the seizures was suggested by their particular pattern: crossed syndromes (facial spasm associated with contralateral weakness of the arm and leg, paroxysmal paraesthesiae in one side of the face and weakness of the contralateral leg), paroxysmal dysarthria, and ataxia. One patient with a Brown-Sequard syndrome complained of paroxysmal paraesthesiae in the lower limbs, for which a spinal origin was admitted. In all patients the paroxysmal disorders were promptly suppressed or markedly reduced by acetazolamide.
This is a report of two women who experienced radiation myelopathy 2,5 and 9 months after telecobalt radiation. Tetraplegia and paralysis of the inspiratory muscles developed rapidly in the first case whereas in the second case the paralysis and the initial Brown-Sequard syndrome improved after treatment with corticosteroids and infusion of Rheomacrodex and Sorbit. It should be stressed that in both cases the radiation stress on the spinal cord was under the limit of tolerance of 3300 to 4000 R. The differential diagnosis of radiation myelopathy from spinal metastasis is most important because the treatment is different for each conditions.
Two patients with vertebral arteriovenous fistulae were treated at the Neurosurgical Clinic of the City Hospital of Hannover between 1981 and 1988. Both patients were males, 19 and 29 year old. The fistulae were secondary to cervical gunshot wounds. Both patients complained of a loud cephalic noise; 1 patient had a non pulsating neck mass. A systolic cervical bruit was heard in both cases. One patient had an incomplete mid-cervical Brown-Sequard syndrome. The fistulae involved the second portion of the vertebral artery: 1 fistula was fed, in addition to the vertebral artery, by the deep cervical artery. Venous drainage was through intraspinal plexus, vertebral vein, deep cervical veins and internal jugular vein. One patient was treated with a direct surgical trapping of the vertebral artery proximal and distal to the fistula: the other patient, in addition to direct surgical vertebral artery trapping, received an endovascular balloon occlusion of the deep cervical artery. After treatment the fistulae disappeared, both clinically and angiographically.
Sensory and motor function scales using a comprehensive neurological examination in emergency departments were developed during a 5-year prospective study of the epidemiology of acute spinal cord injury. Cross-classification of the scales on 133 patients identified 18.8 per cent who had severe motor impairment but minimal or no sensory loss. This discrepancy was not associated with older age or comorbidity but these patients tended to have a higher prevalence of fracture dislocations, hyperesthesia and Brown-Sequard Syndrome. The discrepancy between sensory and motor function was almost certainly due to the pathology of the cord lesion. Overall, motor function was more likely than sensory function to show improvement during the acute hospitalisation. This was especially true for patients admitted with good sensory but poor motor function. These patients need to be delineated soon after injury if we are to fully understand the aetiology of spinal cord injury and appropriately manage and evaluate different therapeutic modalities.
This study was undertaken to improve quantification of the extent of osteoporosis that accompanies spinal cord injuries (SCI) of various types, using single photon densitometry. In this study, we evaluated subjects with complete and incomplete SCI to determine whether there is a correlation between mobility and bone density. We created an index to rank the various levels of mobility among SCI subjects. Mobility index parameters ranged from 1, for complete immobility, to 9, for the full mobility of the uninjured control population. Incomplete SCI subjects (motor and/or sensory) ranked from 2 to 8 on the mobility scale. We also attempted to define clearly the mechanism of osteoporosis in those with predominantly unilateral SCI (Brown-Sequard syndrome). Using single photon absorptiometry (SPA), we found a strong correlation between our mobility index and observed bone density. These observations clearly show that osteoporosis is affected by the subject's level of physical activity. These observations also support the hypothesis that SCI individuals benefit from efforts to maintain a standing posture with some regularity. This effort to improve bone density slows the development of osteoporosis, a process that results in physical impairments in the SCI population.
A rare high cervical intradural subpial lipoma unassociated with spinal dysraphism manifested by a slowly progressive myelopathy simulating Brown-Sequard syndrome in a 37-year-old male. The diagnosis was based on neuroradiological imaging. Intraoperative recording of somatosensory evoked potentials showed recovery of the prolonged N20 latency, indicating adequate decompression was achieved.
Heat stimuli, applied to the skin by non-contact radiation pulses emitted by a CO2-laser, activate simultaneously both A-delta (mean conduction velocity 14 m/s) and C-fibres (0.8 m/s), which terminate in the most superficial skin layers. Correspondingly, brief heat stimuli elicit two pain sensations with mean reaction times of about 500 ms and 1400 ms. Similarly, two evoked potential waveforms were observed in the electroencephalogram: the late components N240/P370 and the ultralate components N1050/P1250. The shape of the two components was reproducible in independent samples of healthy volunteers. In patients with dissociated sensory loss, the laser evoked cerebral potentials are affected, depending on the kind of disturbed nerve and tracts. This is shown in patients with syringomyelia, encephalomyelitis disseminata, myelitis, Brown-Sequard syndrome, Wallenberg syndrome. In cases with hereditary motor and sensory neuropathy type I or with neurosyphilis, ultralate potentials are observed as correlates of delayed pain perception in the affected body areas. The laser evoked cerebral potentials reflected the clinical disorder of pain sensitivity in most cases, whereas somatosensory evoked potentials in response to conventional nerve stimuli failed in objectifying the diagnosis. As such, evoked cerebral potentials in response to laser heat stimuli applied to the hairy skin can be used for an overall examination of the functional integrity of peripheral small fibres, anterolateral tracts and thalamocortical projections.
A case of spontaneous spinal epidural hematoma is reported. The 56-year-old man was hospitalized with neck pain followed by right sided Brown-Sequard syndrome at the level of C5-6 with a light rectovesical insufficiency and cervical sympathetic symptomatology. CT scan revealed right sided extradural high density mass. Following emergency operation removing the epidural hematoma ensured good recovery from the illness. The spontaneous spinal epidural hematoma is rare emergency. The exact etiology is unknown. Etiology and pathophysiology of this unusual lesion are described.
Recent studies relating to soft tissue lesions following irradiation have been concerned with those involving nerves and arteries: Nerve root myelopathies--Brown-sequard's syndrome--spasmodic paraparesis Peripheral neuropathies--plexal disorders--peripheral lesions Carotid stenosis.
During the summers of 1987 and 1988, 14 cervical spine injuries sustained during bodysurfing accidents at the beaches around Ocean City, Maryland presented to our Neurotrauma service. All the patients were men, predominantly in their middle years (mean age = 40), and otherwise healthy. Likely mechanisms of injury suggested by radiography and computed tomography-myelography included hyperflexion, hyperextension, and axial loading. Clinically, neurologic deficits were found in 10 patients (71%), of whom 2 were complete sensorimotor quadriplegics below the level of injury, and 8 were incomplete injuries. Of the eight incomplete injuries, two-thirds were central cord syndromes associated with narrow spinal canals and prominent osteophytes, and one-third had Brown-Sequard or anterior cord syndromes. After initial anatomic realignment by closed or open reduction, the injured cervical spines were stabilized either externally or internally. Two patients underwent laminectomies. These bodysurfing accidents, in marked contrast to other types of shallow water-diving accidents, predominantly involved older men and produced incomplete injuries. It is concluded that bodysurfing is peculiarly hazardous to healthy, middle-aged men, especially those endowed with a narrow spinal canal with or without osteophyte formation.