Brown Sequard Syndrome – Treatment, Symptoms, Causes

What is Brown Sequard Syndrome?

Brown  Sequard Syndrome is otherwise known as Brown Sequard paralysis and Brown Sequard’s Hemiplegia. It deals with the lost of the function of the motor and the sensation which is due to the lateral cutting of the person’s spinal cord.

Other experts define it as a neurological condition which has characteristics of a lesion found in the person’s spinal cord that leads to hemiparaplegia or wherein the half of the body is paralyzed and hemianesthesia or the lost of sensation on the opposite area or side. While others define it as a syndrome that is linked with the injury to the spinal cords lateral half.

Brown Sequard Syndrome History

The name of this syndrome was made in honor of Charles Edouard Brown –Sequard. He was a known neurologist that worked in France, specifically in England and he also worked at the United States of America. He was a Mauritian or British.

He was known to be one of the physicians who founded the Institute of Neurology which is located at London. He also was known to publish 577 papers. At first, he wanted to be a writer however his manuscripts were repeatedly rejected and hence proceeded to become a medical student. He published the findings during 1849 and made it known as the Brown Sequard’s syndrome.

However, it was by the year 1840 when he first discovered such syndrome after cutting in half the spinal cord. It was by then a rare syndrome. Complete hemisection of the spinal cord is unusual and what is usual is the incomplete hemisection of the spinal cord.

This syndrome, he discovered, was later discussed in the British Medical Association upon 1862, during their meeting. He presented the syndrome by telling his observations of farmers who had experience spinal trauma upon cutting of the sugar cane. The French physician named Paul Loye attempted to confirm what Mr. Brown Sequard observations on the person’s nervous system by doing experimentation on the dogs’ decapitation and also other animal’s decapitation. He began to record the extent of the movement of these animals after their decapitation. He was also known to contribute in the field of endocrinology.

Brown Sequard Syndrome Symptoms, Signs

Persons with Brown Sequard Syndrome will manifest the following symptoms:

• Temperature sensation deficit
• Contralateral pain
• Ipsilateral hemiplagia or half of the body is paralyze
• Loss of sensation of half of the body or hemianesthesia
• Babinski sign
• Abnormal reflexes
• Loss of vibration
• Horner’s syndrome
• Sphincter disturbances
• Loss of position sense
• Loss of tactile discrimination

Persons with having Brown Sequard Syndrome with the interruption of the white posterior column, the person will be able to experience an Ipsilateral or on the same side of the loss of vibratory, sense of position and tactile discrimination. Meanwhile, when there is an interruption of the spinothalamic lateral tracts, the person will experience the loss of the sensation under the temperature and the lost of pain.

Brown Sequard Syndrome Causes & Risk Factors

Persons who were diagnosed with Brown Sequard syndrome may have encountered the following etiological factors:

• Ischemia
• Tumor in the person’s spinal cord
• Epidural hematoma
• Penetrating Trauma such as stab or gunshot wounds
• Degenerative disease such as cervical spondylosis and disk herniation

Inflammation or infection such as:

• Multiple sclerosis
• Syphilis
• Tuberculosis
• Myelitis
• Herpes zoster
• Herpes simplex
• Empyema
• Meningitis
• Hemorrhage
• Cystic diseases
• Helminthic parasitic disease (rare)

Brown Sequard Syndrome Diagnosis

Expert physicians will be the one who diagnoses the persons who were positive with Brown Sequard Syndrome. They usually do the following examinations first:

• Medical History Examination
• Physical Examination
• Laboratory studies which is done if infectious disease is the etiological factor
• Radiographs to know the extent of the syndrome
• MRI or magnetic resonance imaging to determine the extent of injury
• CT scans is done especially if MRI is contraindicated
• Ultrasonography also to determine the injury’s extent
• Lumbar puncture for persons with etiological factor of tuberculosis
• Motor examination will reveal paralysis or spastic weakness

Brown Sequard Syndrome Treatment

In treating the persons with Brown Sequard Syndrome, the treatments are aimed at the pathological cause of the syndrome.

Transfusion of blood

If, for instance, the etiological factor is because of a gunshot wound, the treatment is needed to be given instantly for this is an emergency situation because major bleeding and organ damage may occur, leading to a possible death of the person.

Immobilization

Yet, if the person has the syndrome primarily because there is a fracture of the spine which is needed to be identified as soon as possible to prevent further more complication and needs to be appropriately treated. Whenever the person is experiencing either injury of the cervical region or in the spinal cord, there is a need to immobilize the person.

Medication: corticosteroids

Through corticosteroids, the drug will reduce the inflammation found in persons with Brown Sequard syndrome.

Other treatment may be done:

• Occupational therapy
• Recreational therapy
• Physical therapy
• Surgical therapy

Brown Sequard Syndrome Prognosis

There is a generally poor prognosis with persons, who had injuries with the spine resulting to having the Brown Sequard Syndrome. Yet, it may be a better form of spinal cord injury. However some experts say that there is a good prognosis for persons who are on the recovery stage of having a blunt kind of injury. Studies have suggested that when there is a sparing of the motor axon especially the descending part in the contralateral area of the cord may lead to an immediate motor recovery. On the other hand, early treatment will also provide a good prognosis.

Brown Sequard Syndrome Complications

Both the late and early complications that are associated with this kind of syndrome include the following:

• Depression
• Infection
• Pulmonary embolism
• Hypotension
• Disk herniation
• Vertebral artery dissection
• Fracture
• Spinal cord spasm
• Fibromyalgia
• Pressure ulcers
• Bowel impaction