eMedicine Specialties > Physical Medicine and Rehabilitation > Spinal Cord Injury

Brown-Sequard Syndrome: Differential Diagnoses & Workup

Author: Carol Vandenakker-Albanese, MD, Director, Post-Polio Clinic, Department of Physical Medicine and Rehabilitation, University of California at Davis Health System; Physical Medicine and Rehabilitation Residency Director, University of California at Davis
Coauthor(s): Holly Zhao, MD, PhD, Assistant Professor of Clinical Physical Medicine and Rehabilitation, University of California Davis Health System
Contributor Information and Disclosures

Updated: Jul 31, 2008

Differential Diagnoses

Acute Poliomyelitis
Cervical Disc Disease
Decompression Sickness
Guillain-Barre Syndrome
Multiple Sclerosis
Posttraumatic Syringomyelia

Other Problems to Be Considered

Spinal infection
Vascular malformation
Spinal cord tumor, primary or metastatic
Spinal cord herniation
Postradiation spinal cord dysfunction
Eccentric disk herniation with cord compression

Workup

Laboratory Studies

  • Laboratory tests are not routinely required for the diagnosis of Brown-Séquard syndrome, but they may be ordered in situations in which an infectious or neoplastic etiology is suspected.

Imaging Studies

  • Radiographic studies help to confirm the diagnosis and determine the etiology of Brown-Séquard syndrome. Plain films always are required in acute trauma to the spine, but more information usually is obtained by newer techniques. Magnetic resonance imaging (MRI) is very useful in determining the exact structures that have been damaged, as well as in identifying nontraumatic etiologies of Brown-Séquard syndrome. No contrast is necessary for acute injury, but if an intradural etiology is suspected, a gadolinium or phase-contrast cine MRI scan may be helpful.7,8 In persons who are unable to have an MRI scan performed, a computed tomography (CT) myelogram is the study of choice. Imaging is expected to reveal destruction of nerve tissue localized to one side of the spinal cord.9,10
  • The suggested etiology of the syndrome dictates the use of other imaging studies. Angiography is helpful in identifying vascular malformation. Nuclear medicine scans may be necessary to identify infectious or inflammatory causes.

Other Tests

  • Purified protein derivative and sputum for acid-fast bacilli should be ordered if tuberculosis is suggested as an etiology.

Procedures

  • Procedures are performed only for diagnosis of specific suggested etiologies. Diagnosis of multiple sclerosis, transverse myelitis, tumor, or tuberculosis may require lumbar puncture with laboratory analysis of cerebral spinal fluid. Diagnosis of tumor may require open biopsy with tissue pathology or CT scan – guided needle biopsy.

More on Brown-Sequard Syndrome

Overview: Brown-Sequard Syndrome
Differential Diagnoses & Workup: Brown-Sequard Syndrome
Treatment & Medication: Brown-Sequard Syndrome
Follow-up: Brown-Sequard Syndrome
Multimedia: Brown-Sequard Syndrome
References
[ CLOSE WINDOW ]

References

  1. McCarron MO, Flynn PA, Pang KA, et al. Traumatic Brown-Séquard-plus syndrome. Arch Neurol. Sep 2001;58(9):1470-2. [Medline]. [Full Text].

  2. Spinal Cord Injury Information Network. Facts and Figures at a Glance. 2008;[Full Text].

  3. McKinley W, Santos K, Meade M, et al. Incidence and outcomes of spinal cord injury clinical syndromes. J Spinal Cord Med. 2007;30(3):215-24. [Medline]. [Full Text].

  4. Hayes KC, Hsieh JT, Wolfe DL, et al. Classifying incomplete spinal cord injury syndromes: algorithms based on the International Standards for Neurological and Functional Classification of Spinal Cord Injury Patients. Arch Phys Med Rehabil. May 2000;81(5):644-52. [Medline].

  5. Moin H, Khalili HA. Brown Séquard syndrome due to cervical pen assault. J Clin Forensic Med. Apr 2006;13(3):144-5. [Medline].

  6. Chen PY, Lin CY, Tzaan WC, et al. Brown-Sequard syndrome caused by ossification of the ligamentum flavum. J Clin Neurosci. Sep 2007;14(9):887-90. [Medline].

  7. Clatterbuck RE, Belzberg AJ, Ducker TB. Intradural cervical disc herniation and Brown-Séquard's syndrome. Report of three cases and review of the literature. J Neurosurg. Apr 2000;92(2 Suppl):236-40. [Medline].

  8. Jacobsohn M, Semple P, Dunn R, et al. Stab injuries to the spinal cord: a retrospective study on clinical findings and magnetic resonance imaging changes. Neurosurgery. Dec 2007;61(6):1262-6; discussion 1266-7. [Medline].

  9. Parmar H, Park P, Brahma B, et al. Imaging of idiopathic spinal cord herniation. Radiographics. Mar-Apr 2008;28(2):511-8. [Medline].

  10. Miranda P, Gomez P, Alday R, et al. Brown-Sequard syndrome after blunt cervical spine trauma: clinical and radiological correlations. Eur Spine J. Aug 2007;16(8):1165-70. [Medline].

  11. Winchester PK, Williamson JW, Mitchell JH. Cardiovascular responses to static exercise in patients with Brown-Séquard syndrome. J Physiol. Aug 15 2000;527 Pt 1:193-202. [Medline]. [Full Text].

  12. Massicotte EM, Montanera W, Ross Fleming JF, et al. Idiopathic spinal cord herniation: report of eight cases and review of the literature. Spine. May 1 2002;27(9):E233-41. [Medline].

  13. Kohno M, Takahashi H, Yamakawa K, et al. Postoperative prognosis of Brown-Séquard-type myelopathy in patients with cervical lesions. Surg Neurol. Mar 1999;51(3):241-6. [Medline].

  14. Scivoletto G, Cosentino E, Morganti B, et al. Clinical prognostic factors for bladder function recovery of patients with spinal cord and cauda equina lesions. Disabil Rehabil. May 11 2007;1-8. [Medline].

  15. Pollard ME, Apple DF. Factors associated with improved neurologic outcomes in patients with incomplete tetraplegia. Spine. Jan 1 2003;28(1):33-9. [Medline].

  16. Little JW, Halar E. Temporal course of motor recovery after Brown-Sequard spinal cord injuries. Paraplegia. Feb 1985;23(1):39-46. [Medline].

  17. Antich PA, Sanjuan AC, Girvent FM, et al. High cervical disc herniation and Brown-Sequard syndrome. A case report and review of the literature. J Bone Joint Surg Br. May 1999;81(3):462-3. [Medline]. [Full Text].

  18. Blackwell TL, Krause JS, Winkler T, et al. Spinal Cord Injury Desk Reference: Guidelines for Life Care Planning and Case Management. New York, NY: Demos Medical Pub; 2001.

  19. Brugieres P, Malapert D, Adle-Biassette H, et al. Idiopathic spinal cord herniation: value of MR phase-contrast imaging. AJNR Am J Neuroradiol. May 1999;20(5):935-9. [Medline]. [Full Text].

  20. Cervical Spine Research Society, Editorial Committee. The Cervical Spine. 2nd ed. Philadelphia, Pa: Lippincott; 1989.

  21. Ellger T, Schul C, Heindel W, et al. Idiopathic spinal cord herniation causing progressive Brown-Séquard syndrome. Clin Neurol Neurosurg. Jun 2006;108(4):388-91. [Medline].

  22. Francis D, Batchelor P, Gates P. Posttraumatic spinal cord herniation. J Clin Neurosci. Jun 2006;13(5):582-6. [Medline].

  23. Gorman PH, Wuolle KS, Peckham PH, et al. Patient selection for an upper extremity neuroprosthesis in tetraplegic individuals. Spinal Cord. Sep 1997;35(9):569-73. [Medline].

  24. Hwang W, Ralph J, Marco E, et al. Incomplete Brown-Séquard syndrome after methamphetamine injection into the neck. Neurology. Jun 24 2003;60(12):2015-6. [Medline].

  25. Longo MJ, Jaffe CC. Images in clinical medicine. Electrical alternans. N Engl J Med. Dec 30 1999;341(27):2060. [Medline].

  26. Hochschuler SH, Cotler HB, Guyer RD, eds. Rehabilitation of the Spine: Science and Practice. St Louis, Mo: Mosby; 1993.

  27. Stover SL. Clinical Outcomes from the Model Systems. Gaithersburg, Md: Aspen Pubs; 1995.

  28. Tattersall R, Turner B. Brown-Séquard and his syndrome. Lancet. Jul 1 2000;356(9223):61-3. [Medline].

[ CLOSE WINDOW ]

Further Reading

[ CLOSE WINDOW ]

Keywords

Brown-Séquard syndrome, Brown-Séquard's syndrome, Brown-Séquard-plus syndrome, hemisection of the spinal cord, hemisection syndrome, partial spinal sensory syndrome

[ CLOSE WINDOW ]

Contributor Information and Disclosures

Author

Carol Vandenakker-Albanese, MD, Director, Post-Polio Clinic, Department of Physical Medicine and Rehabilitation, University of California at Davis Health System; Physical Medicine and Rehabilitation Residency Director, University of California at Davis
Carol Vandenakker-Albanese, MD is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation, American Association of Neuromuscular and Electrodiagnostic Medicine, American College of Sports Medicine, American Medical Association, American Paraplegia Society, American Spinal Injury Association, Association of Academic Physiatrists, Florida Society of Physical Medicine and Rehabilitation, and Physiatric Association of Spine, Sports and Occupational Rehabilitation
Disclosure: Nothing to disclose.

Coauthor(s)

Holly Zhao, MD, PhD, Assistant Professor of Clinical Physical Medicine and Rehabilitation, University of California Davis Health System
Holly Zhao, MD, PhD is a member of the following medical societies: American Academy of Medical Acupuncture, American Academy of Physical Medicine and Rehabilitation, American Medical Association, and Association of Academic Physiatrists
Disclosure: Nothing to disclose.

Medical Editor

Elizabeth A Moberg-Wolff, MD, Associate Professor and Pediatric PM&R Fellowship Director, Department of Physical Medicine and Rehabilitation, Medical College of Wisconsin; Program Director, Tone Management and Mobility, Department of Physical Medicine and Rehabilitation, Children's Hospital of Wisconsin
Elizabeth A Moberg-Wolff, MD is a member of the following medical societies: American Academy for Cerebral Palsy and Developmental Medicine and American Academy of Physical Medicine and Rehabilitation
Disclosure: Medtronic Neurological Grant/research funds Speaking and teaching

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Michael T Andary, MD, MS, Residency Program Director, Professor, Department of Physical Medicine and Rehabilitation, Michigan State University College of Osteopathic Medicine
Michael T Andary, MD, MS is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation, American Association of Neuromuscular and Electrodiagnostic Medicine, American Medical Association, and Association of Academic Physiatrists
Disclosure: allergan Honoraria Speaking and teaching

CME Editor

Kelly L Allen, MD, Consulting Staff, Department of Physical Medicine and Rehabilitation, Lourdes Regional Rehabilitation Center, Our Lady of Lourdes Medical Center
Disclosure: Nothing to disclose.

Chief Editor

Denise I Campagnolo, MD, MS, Director of Multiple Sclerosis Clinical Research and Staff Physiatrist, Barrow Neurology Clinics, St. Joseph's Hospital and Medical Center; Investigator for Barrow Neurology Clinics; Director, NARCOMS Project for Consort
Denise I Campagnolo, MD, MS is a member of the following medical societies: Alpha Omega Alpha, American Association of Neuromuscular and Electrodiagnostic Medicine, American Paraplegia Society, Association of Academic Physiatrists, and Consortium of Multiple Sclerosis Centers
Disclosure: Teva Neuroscience Honoraria Speaking and teaching; Serono-Pfizer Honoraria Speaking and teaching

 
 
HONcode

We subscribe to the
HONcode principles of the
Health On the Net Foundation

All material on this website is protected by copyright, Copyright© 1994- by Medscape.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.