eMedicine Specialties > Emergency Medicine > Neurology

Brown-Sequard Syndrome: Follow-up

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

Follow-up

Transfer

  • Transfer to a level I trauma center or to a facility with expertise in the care of spinal cord injuries is appropriate; however, transfer should not impede the overall evaluation of these patients, including assessment for possible other injuries.

Complications

  • Complications associated with spinal injury may be present. These may include hypotension initially ("spinal shock") to pulmonary emboli if not prophylactically treated. Subacute and chronic care periods may be complicated by infection to sites such as lungs, urine, etc. Depression frequently occurs in patients with spinal cord injuries and should be observed for in these patients.

Prognosis

  • The prognosis for Brown-Séquard syndrome is poor and depends to a large degree on the etiology of the syndrome. Early treatment with high-dose steroids has shown benefit.

Miscellaneous

Medicolegal Pitfalls

  • Failure to realize that a cord lesion may be partial instead of complete, for example, in the anterior cord, central cord, or as in Brown-Séquard syndrome
    • Try to differentiate levels of sensation loss, motor loss, temperature loss, and vibratory sense loss.
    • Evaluate bilateral versus unilateral neurologic findings when determining level of loss.
  • Failure to consider other injuries, if the cause was traumatic, while focusing only on the spinal cord injury
    • One area commonly neglected is the abdomen; the possibility of intra-abdominal injury must be considered.
    • Always consider imaging of the abdomen/pelvis when the spinal cord is injured.
  • Failure to recognize that hypotension may be the result of something other than neurogenic shock: If the cause of spinal injury is traumatic, always consider hemorrhagic causes of hypotension before assuming it is neurogenic shock.
  • Failure to administer steroids in a timely manner: Initiate steroids promptly on the basis of the initial ED evaluation.
 


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

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  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].

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  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].

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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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