eMedicine Specialties > Emergency Medicine > Neurology

Brown-Sequard Syndrome: Differential Diagnoses & Workup

Author: Michael S Beeson, MD, MBA, FACEP, Professor of Emergency Medicine, Northeastern Ohio Universities College of Medicine; Program Director, Emergency Medicine Residency, Summa Health System
Contributor Information and Disclosures

Updated: Dec 17, 2008

Differential Diagnoses

Fractures, Cervical Spine
Multiple Sclerosis
Spinal Cord Infections
Spinal Cord Injuries
Stroke, Ischemic

Workup

Laboratory Studies

  • 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 be useful in nontraumatic etiologies; otherwise, they do not contribute to diagnosis.

Imaging Studies

  • Spinal plain radiographs may depict bony injury in penetrating or blunt trauma. Lateral mass fracture may cause Brown-Séquard syndrome after blunt injury.
  • MRI defines the extent of spinal cord injury and is helpful when differentiating among nontraumatic etiologies.
  • CT myelography may be useful if MRI is contraindicated or unavailable.

Procedures

  • Patients with traumatic Brown-Séquard syndrome need to be evaluated for the possibility of other injuries, as in any trauma victim. This evaluation may include the following:
    • Bladder catheterization may identify varying degrees of bladder dysfunction in some cases.
    • Immobilization may be required.
    • Nasogastric (NG) tube insertion and subsequent low-wall suction may help to prevent aspiration. Additionally, these patients are prone to developing ileus in the acute stage.
    • Cervical spine immobilization, or lower dorsal vertebra immobilization, is required with trauma or suspicion of an unstable spine. Hard-collar immobilization or Gardner Wells tongs may be required if cervical fracture/injury is identified.
    • Patients with Brown-Séquard syndrome have varying levels of sensation loss, mandating investigation of possible intra-abdominal injury, for example, through CT scan or ultrasonography.

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
References
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References

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

  2. 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. Nov 2007;7(5):571-4. [Medline].

  3. Egido Herrero JA, Saldana C, Jimenez A, et al. Spontaneous cervical epidural hematoma with Brown-Sequard syndrome and spontaneous resolution. Case report. J Neurosurg Sci. Apr-Jun 1992;36(2):117-9. [Medline].

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

  5. Finelli PF, Leopold N, Tarras S. Brown-Sequard syndrome and herniated cervical disc. Spine. May 1992;17(5):598-600. [Medline].

  6. Hancock JB, Field EM, Gadam R. Spinal epidural hematoma progressing to Brown-Sequard syndrome: report of a case. J Emerg Med. May-Jun 1997;15(3):309-12. [Medline].

  7. Harris P. Stab wound of the back causing an acute subdural haematoma and a Brown-Sequard neurological syndrome. Spinal Cord. Nov 2005;43(11):678-9. [Medline].

  8. Henderson SO, Hoffner RJ. Brown-Sequard syndrome due to isolated blunt trauma. J Emerg Med. Nov-Dec 1998;16(6):847-50. [Medline].

  9. Hwang W, Ralph J, Marco E, Hemphill JC 3rd. Incomplete Brown-Sequard syndrome after methamphetamine injection into the neck. Neurology. Jun 24 2003;60(12):2015-6. [Medline].

  10. Kraus JA, Stuper BK, Berlit P. Multiple sclerosis presenting with a Brown-Sequard syndrome. J Neurol Sci. 1998;156(1):112-3. [Medline].

  11. Lee JK, Kim YS, Kim SH. Brown-Sequard syndrome produced by cervical disc herniation with complete neurologic recovery: report of three cases and review of the literature. Spinal Cord. Nov 2007;45(11):744-8. [Medline].

  12. Lim E, Wong YS, Lo YL, Lim SH. Traumatic atypical Brown-Sequard syndrome: case report and literature review. Clin Neurol Neurosurg. Apr 2003;105(2):143-5. [Medline].

  13. Mastronardi L, Ruggeri A. Cervical disc herniation producing Brown-Sequard syndrome: case report. Spine. Jan 15 2004;29(2):E28-31. [Medline].

  14. Miyake S, Tamaki N, Nagashima T, et al. Idiopathic spinal cord herniation. Report of two cases and review of the literature. J Neurosurg. Feb 1998;88(2):331-5. [Medline].

  15. Moon SJ, Lee JK, Kim TW, Kim SH. Idiopathic transverse myelitis presenting as the Brown-Sequard syndrome. Spinal Cord. Mar 11 2008;[Medline].

  16. Rumana CS, Baskin DS. Brown-Sequard syndrome produced by cervical disc herniation: Case report and literature review. Surg Neurol. 1996;45(4):359-361. [Medline].

  17. Stephen AB, Stevens K, Craigen MA, Kerslake RW. Brown-Sequard syndrome due to traumatic brachial plexus root avulsion. Injury. Oct 1997;28(8):557-8. [Medline].

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Further Reading

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Keywords

spinal cord lesion, Brown-Sequard's syndrome, Brown-Séquard syndrome, Brown-Séquard's syndrome, Brown-Sequard paralysis, Brown-Séquard paralysis, Brown-Séquard's paralysis, hemisection of the spinal cord, ipsilateral hemiplegia, penetrating injury to the spine, incomplete spinal cord lesion

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Contributor Information and Disclosures

Author

Michael S Beeson, MD, MBA, FACEP, Professor of Emergency Medicine, Northeastern Ohio Universities College of Medicine; Program Director, Emergency Medicine Residency, Summa Health System
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.

Medical Editor

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.

Pharmacy Editor

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

Managing Editor

J Stephen Huff, MD, Associate Professor, Emergency Medicine and Neurology, Department of Emergency Medicine, University of Virginia Health Sciences Center
J Stephen Huff, MD is a member of the following medical societies: American Academy of Emergency Medicine, American Academy of Neurology, American College of Emergency Physicians, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

CME Editor

John D Halamka, MD, MS, Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center
John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Chief Editor

Jonathan Adler, MD, Attending Physician, Department of Emergency Medicine, Massachusetts General Hospital; Division of Emergency Medicine, Harvard Medical School
Jonathan Adler, MD is a member of the following medical societies: American Academy of Emergency Medicine and Society for Academic Emergency Medicine
Disclosure: eMedicine.com, Inc. Consulting fee Consulting

 
 
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