eMedicine Specialties > Emergency Medicine > Neurology

Brown-Sequard Syndrome

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

Introduction

Background

Brown-Séquard syndrome is an incomplete spinal cord lesion characterized by a clinical picture reflecting hemisection of the spinal cord, often in the cervical cord region. It was first described in the 1840s after Dr. Charles Edouard Brown-Sequard sectioned half of the spinal cord. It is a rare syndrome, consisting of ipsilateral hemiplegia with contralateral pain and temperature sensation deficits because of the crossing of the fibers of the spinothalamic tract.

Pathophysiology

The pure Brown-Séquard syndrome reflecting hemisection of the cord is not often observed. A clinical picture comprising fragments of the syndrome or the hemisection syndrome plus additional symptoms and signs is more common. Interruption of the lateral corticospinal tracts, the lateral spinal thalamic tract, and at times the posterior columns produces a picture of a spastic weak leg with brisk reflexes and a strong leg with loss of pain and temperature sensation. Note that spasticity and hyperactive reflexes may not be present with an acute lesion.

Frequency

United States

Brown-Sequard syndrome is a seldom encountered syndrome, usually the result of penetrating trauma to the cervical or thoracic spine. It is also associated rarely with herniated cervical disks.

Mortality/Morbidity

Brown-Sequard syndrome morbidity and mortality is related to the initial associated injuries that may have occurred with the insult that created Brown-Sequard. Often the result of penetrating trauma, other wounds may coexist that threaten exsanguinating hemorrhage. Morbidity is associated with the resulting hemiplegia, with infection a significant long-term risk.

Clinical

History

Brown-Séquard syndrome may be the result of penetrating injury to the spine, but many other etiologies have been described. Complete hemisection, causing classic clinical features of pure Brown-Séquard syndrome, is rare. Incomplete hemisection causing Brown-Séquard syndrome plus other signs and symptoms is more common. These symptoms may consist of findings from posterior column involvement such as loss of vibratory sensation.

Physical

Partial Brown-Séquard syndrome is characterized by asymmetric paresis with hypalgesia more marked on the less paretic side. Pure Brown-Séquard syndrome is associated with the following:

  • Interruption of the lateral corticospinal tracts
    • Ipsilateral spastic paralysis below the level of the lesion
    • Babinski sign ipsilateral to lesion
    • Abnormal reflexes and Babinski sign may not be present in acute injury.
  • Interruption of posterior white column - Ipsilateral loss of tactile discrimination, vibratory, and position sensation below the level of the lesion
  • Interruption of lateral spinothalamic tracts: Contralateral loss of pain and temperature sensation. This usually occurs 2-3 segments below the level of the lesion.

Causes

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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  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].

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  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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