Close
New

Medscape is available in 5 Language Editions – Choose your Edition here.

 

Brown-Sequard Syndrome Workup

  • Author: Carol Vandenakker-Albanese, MD; Chief Editor: Stephen Kishner, MD, MHA  more...
 
Updated: Mar 28, 2014
 

Approach Considerations

The diagnosis of Brown-Séquard syndrome is made on the basis of history and physical examination. Laboratory work is not necessary to evaluate for the condition but may be helpful in following the patient's clinical course. Laboratory studies may also be useful in nontraumatic etiologies, such as infectious or neoplastic causes. Purified protein derivative and sputum for acid-fast bacilli should be ordered if tuberculosis is suggested as an etiology.

If the cause of the SCI was traumatic, do not fail to consider that other injuries may be present as well. One commonly neglected area is the abdomen; the possibility of intra-abdominal injury must be taken into account. Always consider imaging of the abdomen/pelvis when the spinal cord is injured.

Recognize that hypotension may be the result of something other than neurogenic shock. If, for example, the spinal injury was caused by trauma, hypotension may result from hemorrhagic causes.

Bladder catheterization

Bladder catheterization may identify varying degrees of bladder dysfunction in some cases.

Lumbar puncture

Lumbar puncture is performed only for the diagnosis of specific, suggested etiologies. The diagnosis of multiple sclerosis, transverse myelitis, tumor, or tuberculosis may require lumbar puncture with laboratory analysis of cerebral spinal fluid. Tumor diagnosis may require open biopsy with tissue pathology or computed tomography (CT) scan–guided needle biopsy.

Next

Imaging Studies

Radiography

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.

Spinal plain radiographs may depict bony injury in penetrating or blunt trauma. Lateral mass fracture may cause Brown-Séquard syndrome after blunt injury.

MRI

Magnetic resonance imaging (MRI) is very useful in determining the exact structures that have been damaged in Brown-Séquard syndrome, as well as in identifying nontraumatic etiologies of the disorder. 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.[15, 16]

CT scanning

In persons who are unable to have an MRI scan performed, a CT myelogram is the study of choice. Imaging is expected to reveal destruction of nerve tissue localized to one side of the spinal cord.[17, 18]

Other

The suggested etiology of Brown-Séquard syndrome can dictate the use of imaging studies other than radiography, CT scanning, and MRI. Angiography is helpful in identifying vascular malformation. Nuclear medicine scans may be necessary to identify infectious or inflammatory causes.

Previous
 
 
Contributor Information and Disclosures
Author

Carol Vandenakker-Albanese, MD Professor, Department of Physical Medicine and Rehabilitation, University of California Davis Health System; Physical Medicine and Rehabilitation Residency Director, University of California, Davis, School of Medicine

Carol Vandenakker-Albanese, MD is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation, North American Spine Society, American College of Sports Medicine, Association of Academic Physiatrists

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, Association of Academic Physiatrists

Disclosure: Nothing to disclose.

Chief Editor

Stephen Kishner, MD, MHA Professor of Clinical Medicine, Physical Medicine and Rehabilitation Residency Program Director, Louisiana State University School of Medicine in New Orleans

Stephen Kishner, MD, MHA is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation, American Association of Neuromuscular and Electrodiagnostic Medicine

Disclosure: Nothing to disclose.

Acknowledgements

Michael T Andary, MD, MS Professor, Residency Program Director, 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; Pfizer Honoraria Speaking and teaching

Michael S Beeson, MD, MBA, FACEP Professor of Emergency Medicine, Northeastern Ohio Universities College of Medicine and Pharmacy; Attending Faculty, Akron General Medical Center

Michael S Beeson, MD, MBA, FACEP is a member of the following medical societies: American College of Emergency Physicians, Council of Emergency Medicine Residency Directors, National Association of EMS Physicians, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Samuel M Keim, MD Associate Professor, Department of Emergency Medicine, University of Arizona College of Medicine

Samuel M Keim, MD is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, American Medical Association, American Public Health Association, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Elizabeth A Moberg-Wolff, MD Associate Professor, Department of Physical Medicine and Rehabilitation, Children's Hospital of Wisconsin, Medical College 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

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

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

  2. Musker P, Musker G. Pneumocephalus and Brown-Sequard syndrome caused by a stab wound to the back. Emerg Med Australas. 2011 Apr. 23(2):217-9. [Medline].

  3. Mac-Thiong JM, Parent S, Poitras B, Joncas J, Labelle H. Neurological Outcome and Management of Pedicle Screws Misplaced Totally Within the Spinal Canal. Spine (Phila Pa 1976). 2012 Jul 18. [Medline].

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

  5. Urrutia J, Fadic R. Cervical disc herniation producing acute Brown-Sequard syndrome: dynamic changes documented by intraoperative neuromonitoring. Eur Spine J. 2012 Jun. 21 Suppl 4:S418-21. [Medline]. [Full Text].

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

  7. Lipper MH, Goldstein JH, Do HM. Brown-Séquard syndrome of the cervical spinal cord after chiropractic manipulation. AJNR Am J Neuroradiol. 1998 Aug. 19(7):1349-52. [Medline].

  8. Domenicucci M, Ramieri A, Salvati M, Brogna C, Raco A. Cervicothoracic epidural hematoma after chiropractic spinal manipulation therapy. Case report and review of the literature. J Neurosurg Spine. 2007 Nov. 7(5):571-4. [Medline].

  9. Spinal Cord Injury Information Network. Facts and Figures at a Glance. February. [Full Text].

  10. 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].

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

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

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

  14. 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. 2000 May. 81(5):644-52. [Medline].

  15. 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. 2000 Apr. 92(2 Suppl):236-40. [Medline].

  16. 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. 2007 Dec. 61(6):1262-6; discussion 1266-7. [Medline].

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

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

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

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

  21. 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. 2007 May 11. 1-8. [Medline].

 
Previous
Next
 
American Spinal Injury Association (ASIA) standard neurologic classification of spinal cord injury.
American Spinal Injury Association (ASIA) Impairment Scale.
 
 
 
All material on this website is protected by copyright, Copyright © 1994-2016 by WebMD LLC. This website also contains material copyrighted by 3rd parties.