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What Is Brown-Séquard Syndrome?
Brown-Séquard syndrome is a rare and treatable neurological disease in which there is muscle weakness (or paralysis) on one side of the body and loss of sensation on the other side. It can happen due to various traumatic and non-traumatic causes.
Dr. Charles-Edouard Brown-Séquard first described this neurological syndrome in the 1840s. It occurs in around 2% to 4% of people with traumatic SCIs in the United States.
The spinal cord is a delicate cylindrical tube that extends from the base of your brain through the spine up to the tailbone. It's made of bundles of nerves that send signals to and from the brain to all parts of your body.
Since the spinal cord is the carrier of information for your entire body, damage to any section affects all the body parts with nerves connected to that area. For example, a complete SCI will result in the total loss of function and sensation in all body parts below the level of the injury.
Brown-Séquard syndrome, also known as lateral cord syndrome, occurs due to injury to one side of the spinal cord and can happen at any level. Because this syndrome results from a partial injury, the function in some parts of the spinal cord is preserved.
What Are Some Brown-Séquard Syndrome Causes?
Brown-Séquard syndrome usually happens due to spinal damage caused by stab or gunshot wounds, falls, vehicular accidents, or blunt force trauma.
Non-traumatic causes include:
- Genetic spinal malformations
- Infections like meningitis, myelitis, herpes, and tuberculosis
- Radiation exposure
- Multiple sclerosis
- Epidural hematomas, in which blood collects inside the skull
- Spinal ischemia, in which there's decreased blood supply to the spine due to blocked vessels
- Spinal disorders like cervical spondylosis
- Arachnoid cysts (brain cysts)
- Intravenous drug use, which can contribute to brain abscesses
- Spinal cord tumors
- Herniated discs
- Decompression sickness
What Are Brown-Séquard Syndrome Symptoms?
The earliest symptoms include loss of voluntary muscle movement function on the same side as the traumatic SCI and loss of pain and temperature sensation on the opposite side of the SCI below the level of the injury.
You can understand this as follows. Suppose you injure your right spinal cord at the chest level: you would lose your voluntary movement ability on the right side, all the way from the injury level to the right hip, knee, and foot. You would experience muscle weakness and maybe partial paralysis. On the left side of your body below the injury level, you would still retain muscle control but would lose the ability to detect pain and temperature sensations. All your body parts above the chest would remain unaffected and function normally.
Brown-Séquard syndrome symptoms can range from mild to severe depending on the extent of the injury. While Brown-Séquard syndrome itself doesn’t cause pain, the SCI that led to Brown-Séquard syndrome can be painful. Because of the sensory nerve damage in Brown-Séquard syndrome, you’re more likely to experience abnormal sensations like tingling, burning, prickling, or aching.
Other Brown-Séquard syndrome symptoms include incontinence, weakness, and affected muscle wasting due to lack of use. Most of these symptoms can be reversed with proper treatment. More than 90% of people with Brown-Séquard syndrome regain bowel and bladder control as well as the ability to walk.
How Is Brown-Séquard Syndrome Diagnosed?
Your doctor may likely suspect Brown-Séquard syndrome based on your medical and trauma history, physical exam, and neurological tests and make a clinical diagnosis. Next, they’ll recommend certain confirmatory tests to determine the cause of the Brown-Séquard syndrome. These include:
1. Magnetic resonance imaging (MRI). This test uses a huge magnet, radio waves, and a computer to capture clear images of your internal organs. MRI is most useful in such cases because it’s sensitive enough to pick up on structural damage in traumatic SCIs. For non-traumatic causes, MRI can detect ligament injuries and minute bleeds.
2. Myelogram with computed tomography (CT) or CT myelography. If you can’t take an MRI scan due to various reasons like having a pacemaker, the next best thing is a myelogram followed by a CT scan. These techniques use a contrast dye, X-rays, and a computer to take detailed images of your spine and other internal structures. This will help doctors examine the damage to your spinal cord, vertebrae, intervertebral discs, and nerves to identify the cause of your Brown-Séquard syndrome.
3. Blood tests. Once your doctor has ruled out trauma or structural malformations, they may request blood tests to look for other causes like infection and cancer.
4. Lumbar puncture (spinal tap) with cerebrospinal fluid analysis. This is used if your doctor is suspecting tuberculosis, multiple sclerosis, or transverse myelitis as the cause of Brown-Séquard syndrome.
How Is Brown-Séquard Syndrome Treated?
Treatment plans vary depending on the cause of the Brown-Séquard syndrome. But all treatments are focused on preserving motor and sensory function and minimizing complications. In many cases, high doses of steroids (methylprednisolone) are given as early treatment (within eight hours of injury) to recover motor function. This can increase the risk of infections, so it can’t be used in all cases, especially if there’s a penetrating injury or infectious cause. Brown-Séquard syndrome treatment occurs in two phases:
Symptomatic and supportive treatment. This can include:
- Medications like blood thinners to prevent blood clots
- Surgery (if required) to alleviate spinal compression
- Skincare to minimize pressure injuries like bedsores
- Feeding (gastrostomy) tube placement to provide nutrition, since the intestinal muscles may be weakened
- Breathing support (if required)
- Bowel and bladder support like a urinary catheter, suppositories, or stool softeners to manage incontinence and constipation
- Blood pressure and heart medications if there are fluctuations
- Medications to manage neuropathic pain
- Temperature-regulating blankets, since people with Brown-Séquard syndrome have hampered temperature sensations
Rehabilitation. This includes physical and occupational therapy to ease pain, improve mobility, maintain muscle strength and range of motion in the joints, protect your skin from breaking down by regular weight shifting and proper positioning, and learn new or adaptive techniques to perform regular tasks. You may also require braces, hand splints, limb supports, or a wheelchair.
What Complications Can Occur in Brown-Séquard Syndrome?
If your Brown-Séquard syndrome is not treated, you could experience the following complications:
- Low blood pressure
- Spinal shock
- Abdominal enlargement
- Lung and urinary tract infections
- Blood clots in the lung
- Irreversible paralysis
In people who have also received injuries to the chest and neck, doctors may need to provide breathing assistance.
Living With Brown-Séquard Syndrome
Although the outcome varies based on the cause of Brown-Séquard syndrome, the overall results are usually good.
The healing process may be slow, requiring three months to two years for neurological recovery, but there’s a high success rate. With timely treatment and rehabilitation, more than 90% of people can walk without assistance.
Don’t panic or be disheartened if you or your loved ones receive a Brown-Séquard syndrome diagnosis. Be consistent with your medications, doctor visits, and rehabilitation efforts, and you’re very likely to eventually see tremendous improvement in your quality of life.