Updated: 7/9/2020

Brown-Sequard Syndrome

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Evidence
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Topic
Overview
 

 
Snapshot
  • A 17-year-old man presents to the emergency department after a physical altercation that resulted in a stab wound. He was stabbed at level T12 in the back. On physical examination, there is significant muscle weakness affecting the whole right lower extremity. There is also impaired vibration and proprioception sense of the right leg and loss of pain and temperature sense of the left leg.
Introduction
  • Clinical definition
    • a spinal cord lesion secondary to hemisection injury
  • Etiology
    • penetrating trauma
    • blunt trauma
    • disc or bone herniation
    • spinal cord hematoma or tumor
Presentation
  • Symptoms
    • at the site of the lesion you have ipsilateral
      • lower motor neuron (LMN) signs
      • loss of all sensation
    • below the site of the lesion you have ipsilateral 
      • upper motor neuron (UMN) signs
        • due to involvement of the corticospinal tract
      • loss of proprioception, light touch, and vibration sense
        • due to involvement of the dorsal column medial lemniscus pathway
    • below the site of the lesion you have contralateral
      • loss of pain, temperature, and crude touch
        • due to involvement of the spinothalamic tract
    • an ipsilateral Horner syndrome may result if
      • the spinal cord lesion occurs above T1
        • due to involvement of the oculosympathetic pathway
 

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(M1.NE.17.4694) A 27-year-old gentleman is brought into the ED after being stabbed in the back by a knife. In addition to the pain from the wound, he complains of weakness in his left leg. Upon physical examination you find that he has no other visible injuries; however, he has 2/5 strength in the left lower extremity. Complete neurologic exam also finds a deficit in vibration sense and light touch on the left lower extremity as well as a loss of pain and temperature sensation in the right lower extremity. Which of the following lesions would result in the syndrome described?

QID: 107890
1

Anterior cord lesion

8%

(21/279)

2

Posterior cord lesion

11%

(30/279)

3

Right cord hemisection

16%

(44/279)

4

Left cord hemisection

59%

(165/279)

5

Complete cord transection

3%

(9/279)

M 2 B

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Evidence (3)
EXPERT COMMENTS (13)
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