eMedicine Specialties > Physical Medicine and Rehabilitation > Spinal Cord Injury

Brown-Sequard Syndrome: Follow-up

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

Follow-up

Further Inpatient Care

  • After acute hospitalization and inpatient rehabilitation, further inpatient care is not necessary except in the event of a significant medical complication.

Further Outpatient Care

  • Basic medical follow-up care for SCI is recommended every 1-3 years. The suggested assessments include full history and physical (eg, weight, vital signs), vital capacity if the injury level is above T6, routine blood tests, neurologic evaluation with ASIA scoring, and cardiac risk assessment. Urologic evaluation also is recommended, but it is not necessary if a patient with Brown-Séquard syndrome has regained normal bladder function.
  • Brown-Séquard syndrome carries a more favorable prognosis than do most SCIs, with ongoing neurologic recovery occurring for up to 2 years following the injury. As long as a person's neurologic status is improving and his/her rehabilitation goals change, ongoing physical and occupational therapy are indicated. Following achievement of an optimal functional level, assessment by a physical therapist, occupational therapist, psychosocial counselor, and therapeutic recreation specialist is recommended every 1-3 years.
  • In the patient who recovers ambulatory function, regular evaluation of any orthotics or assistive devices also is necessary to ensure safety and prevent skin breakdown.

Inpatient & Outpatient Medications

  • Medication use is dependent on the secondary effects of SCI. Medication may be indicated for spasticity, pain, or a number of other possible complications. Please refer to individual articles on secondary effects for information on recommendations about medications. In general, persons with Brown-Séquard syndrome regain significant function, and many of these medications are not needed long term.

Deterrence

  • A number of community outreach programs have been developed to educate young people about the risks of traumatic injury associated with certain behaviors. Results of such injury, such as SCI, are described in detail, and preventive measures are outlined. These programs have been found to have a positive impact on the rate of injury.
  • Nontraumatic etiologies of Brown-Séquard syndrome are best prevented through early recognition and treatment of the underlying pathology.

Complications

  • Potential long-term complications of Brown-Séquard syndrome are similar to those associated with aging and SCI. Lower extremity problems related to ambulation may increase, but this phenomenon has not been documented in the literature.

Prognosis

  • A retrospective review of 412 patients with traumatic, incomplete cervical SCIs examined variables associated with improved neurologic outcomes.15 The most important prognostic variable relating to neurologic recovery was found to be completeness of the lesion. If the cervical spinal cord lesion is incomplete, younger patients with central cord or Brown-Séquard syndrome have the more favorable prognosis for recovery. Recovery was not linked to high-dose steroid administration, early surgical intervention, or surgical decompression in stenotic patients without fracture.
  • Prognosis for significant motor recovery in Brown-Séquard syndrome is good.3 One half to two thirds of the 1-year motor recovery occurs within the first 1-2 months following injury. Recovery then slows but continues for 3-6 months and has been documented to progress for up to 2 years following injury.
  • The most common pattern of recovery includes the recovery of the ipsilateral proximal extensor muscles prior to that of the ipsilateral distal flexors, recovery from weakness in the extremity with sensory loss before recovery occurs in the opposite extremity, and the recovery of voluntary motor strength and a functional gait within 1-6 months.16 Studies suggest that spared descending motor axons in the contralateral cord may mediate much of the motor recovery. Most individuals with incomplete injuries at the time of initial examination recover the ability to ambulate.

Patient Education

  • Patient education occurs throughout all phases of care, from the time of diagnosis through acute hospitalization, rehabilitation, and community re-entry. Initially, the patient is informed about the diagnosis and its implications. During hospitalization, treatment is explained and rehabilitation is introduced. Extensive education on body system functions, social and psychological effects, coping strategies, and community re-integration is presented. Education for the patient with Brown-Séquard syndrome continues throughout life, using various mechanisms.
  • For excellent patient education resources, visit eMedicine's Environmental Exposures and Injuries Center. Also, see eMedicine's patient education article The Bends - Decompression Syndromes.

Miscellaneous

Medicolegal Pitfalls

  • Special care must be taken in preparing a life-care plan for a patient with Brown-Séquard syndrome. The incompleteness of the syndrome in conjunction with a good prognosis for recovery makes determination of needs over a lifetime difficult. If evaluated too early, needs may be grossly overestimated. If evaluation is performed at the time of maximal function, the expected difficulties and changes associated with aging with disability must not be forgotten.
 


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
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References

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  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].

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  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].

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  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].

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  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].

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

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Further Reading

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Keywords

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

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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

 
 
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