Brown-Sequard Syndrome

Brown-Sequard syndrome is an uncommon or rare neurological syndrome that is caused by a spinal cord (spinalcord) or lesion. This syndrome is manifested by hemiparaplegia – weakness and paralysis on one side of the body, and hemianasthesia or sensation loss on the other side of the body. This syndrome is associated with the lateral part of the spinal cord (spinalcord) and since it affects less than 200,000 people in the United States, it has been termed as a “rare disease” by the Office of Rare Diseases at the National Institute of Health. The renowned Mauritian neurologist, Charles Edouard Brown Sequard, first described this syndrome in 1850 after observing spinal cord (spinalcord) or trauma among sugar cane farmers in Mauritius.

Diagnosis

Brown-Sequard syndrome is diagnosed generally through the use of an MRI Scan. Since it consists of an incomplete lesion in the spinal cord (spinalcord), a clinical examination is conducted to reflect on the spinal cord’s hemisection. The initial symptoms of motor paralysis on the same side as the lesion, and decreased pain and temperatures on the other side, have lead to a diagnosis of this unusual and rare syndrome.

Symptoms

There are some important symptoms that point towards the existence of the syndrome.

  • Hemiparaplegia – or paralysis on the side where the lesion exists
  • Hemianasthesia – or lessened sensation on the other side
  • There is paralysis of the voluntary muscles below the level of the lesion
  • Sensory loss at the level of the lesion
  • Increase in the muscle tone at the side of the lesion

There are other similar symptoms such as loss of sense of touch and vibration on one side, and loss of sense of pain and temperature on the other side.

Causes

This rare spinal cord disorder is generally the result of a spinal cord injury where the cord has been hurt, but has not been severed completely. An injury to the spine near the neck or the back can lead to this disorder, and so will a puncture wound in the spine. It can also be caused by a spinal cord tumor; the obstruction of a blood vessel known as ischemia; occasionally from inflammatory diseases such as multiple sclerosis and tuberculosis. Other non-traumatic causes could be:

  • Radiation
  • Intravenous drug use
  • Meningitis
  • Herpes Roster
  • Herpes Simplex
  • Syphilis
  • Vertebral Artery Dissection
  • Epidural Hematoma

Demographics

The SCI survey and database has shown that 63 % of this syndrome has occurred in white or the Caucasian population since 2000, 11.8 % in Hispanics, 22.7 % in African Americans, and the rest in other racial and ethnic groups. Demographic data has also shown that more men have the syndrome, though this may be due to a greater spinal cord injury and may not reflect the non-traumatic causes. A spinal cord injury occurs mainly among people between the ages of 16-30, but the average age has been increasing over the years. Today, the average age of individuals with the Brown-Sequard syndrome is 40 years.

Prognosis

It has been seen that the chances of significant motor recovery among those who suffer from this syndrome are good. Following the injury, one half to two thirds of the motor recovery happens within the first two months. Post that, the speed of the recovery slows down and it continues till the second year. The general pattern of recovery is as follows:

  • Recovery of the epsilateral proximal extensor muscles
  • Recovery from weakness in the side
  • Recovery of the voluntary motor strength, and a return to normal walking and gait in the next phase

A lot depends on the completeness of the lesion. Younger patients have a greater chance of better recovery if the cervical cord lesion is not complete, as in the case of a Brown-Sequard syndrome.

Treatment

As in any disease, the treatment is based upon the causes of the trauma or the reasons behind the paralysis. If it is due to a gunshot injury or any other injury to the spine, then the next step would be to deal with other aspects of the injury, such as bleeding and organ damage. If there is a spinal fracture, then that must be treated on an emergency basis, and the Brown-Sequard syndrome will be dealt with later. In this case, immobilisation of the patient is of extreme importance. Medication of the syndrome is generally in the form of steroids, which are used to decrease the inflammation. There are different types of therapies that are useful in treating this syndrome. These are occupational, recreational, physical and surgical therapy. Early treatment always results in a good prognosis, though in some cases where the motor injury is severe, the chances of a full recovery or a return to normal life are not so great.

Complications

There are some complications that follow the occurrence of the syndrome. These may be the results of the trauma or could be a part of the overall problems in the body. The complications that could result due to the Brown-Sequard syndrome are:

  • Osteoporosis
  • Hypercalcemia
  • Depression
  • Hypotension
  • Spinal Cord Injury or Spasm
  • Pressure ulcers
  • Bowel Impaction
  • Vertebral Artery Dissection

It is important to undergo as many tests as possible before reaching the syndrome diagnosis stage. There have been many cases of misdiagnosis, since the symptoms may be similar to B12 deficiency or multiple sclerosis. MRI’s, CT Scans, motor examination of the muscles, lumbar punctures, especially for those suffering from tuberculosis, and laboratory tests help determine the extent, if any, of the infectious diseases.