Brown-Séquard Syndrome

Brown-Séquard Syndrome is a condition where there's anatomical disruption of nerve fibre tracts in one half of the spinal cord. This disruption affects the ascending spinothalamic tracts, ascending dorsal columns (both sensory), and descending lateral corticospinal tracts (motor).

This is most commonly occurs due to trauma, particularly penetrating injuries e.g. stabbing. Other causes include:

• Malignancy

• Disk prolapse

• Infection

• Epidural haematomas

Presentation

• Changes to sensory function

  • Dorsal column - This is responsible for fine touch, vibration, two-point discrimination, and proprioception. These sensations would be affected ipsilateral to the lesion because the fibres ascend ipsilaterally before decussating (crossing over) at the lower medulla.

  • Spinothalamic tract - This is responsible for pain, temperature, and crude touch. These sensations would be affected contralateral to the lesion because the fibres ascend a level up and then decussate to the opposite side of the cord.

• Changes to motor function

  • Corticospinal tract - There would be an ipsilateral loss of movement and paralysis. There would be LMN signs at the level of the lesion, and UMN signs below the lesion. There is no significant motor deficit on the contralateral side.

N.B. Only the spinothalamic tract decussates within the spinal cord itself, leading to the contralateral side being affected. Important to think of Brown-Sequard in any patient coming in with a penetrating injury and only has loss of pain and temperature sensation on the contralateral side to the injury.

Management

The need for conservative or surgical management is dependant on the patient’s neurological status and the radiological findings. Surgery is usually indicated in traumatic causes.