eMedicine Specialties > Emergency Medicine > Neurology

Brown-Sequard Syndrome: Treatment & Medication

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

Treatment

Prehospital Care

The key to successful prehospital care of patients with Brown-Séquard syndrome is to suspect a cervical or other spinal injury. A low threshold for cervical spine/backboard immobilization is appropriate. One issue with prehospital evaluation of cervical spine injury is the potential for assumption of a complete spinal cord lesion rather than an incomplete lesion. Prehospital providers must be educated to the findings of incomplete cord syndromes and how to make a brief assessment of complete versus incomplete cord lesion.

Emergency Department Care

  • Care in the ED consists of a thorough evaluation, including neurologic examination for level of injury. Careful cervical spine/dorsal spine immobilization is necessary, with elimination of neck movement.
  • The nature of sensory loss makes investigation of other injuries more difficult. This mandates thorough and complete physical examination, relying on imaging studies to supplement physical examination.

Consultations

  • Neurosurgical or orthopedic consultation is necessary. Practice patterns may dictate involvement of different services. It is essential that physical medicine and rehabilitation specialists be consulted early on in the initial stages of their care.

Medication

The goal of pharmacotherapy is to prevent complications.

Corticosteroids

Multiple studies have demonstrated the improved outcomes of patients with traumatic spinal cord injuries who are given high-dose steroids early in the clinical course.


Methylprednisolone (Solu-Medrol, Depo-Medrol)

Decreases inflammation by suppressing polymorphonuclear leukocytes and reversing increased capillary permeability.

Adult

30 mg/kg IV bolus over 15 min, then 5.4 mg/kg/h infusion for 23 h; should be initiated within 8 h of injury

Pediatric

Administer as in adults (NACSIS study enrolled patients as young as 13 y)

Coadministration with digoxin may increase digitalis toxicity secondary to hypokalemia; estrogens may increase levels; phenobarbital, phenytoin, and rifampin may decrease levels (adjust dose); monitor patients for hypokalemia when taking medication concurrently with diuretics

Documented hypersensitivity; viral, fungal, or tubercular skin infections

Pregnancy

B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals

Precautions

Slightly higher rates of wound infection and GI bleeding in methylprednisolone group in the NACSIS study (not statistically significant); other possible complications include hyperglycemia, edema, osteonecrosis, peptic ulcer disease, hypokalemia, osteoporosis, euphoria, psychosis, growth suppression, myopathy, and infections

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].

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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].

  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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