Brown-Sequard Syndrome Workup
- Author: Carol Vandenakker-Albanese, MD; Chief Editor: Stephen Kishner, MD, MHA more...
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 may identify varying degrees of bladder dysfunction in some cases.
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.
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.
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]
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]
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.
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