Traumatic Brown-Séquard syndrome: modern reminder of a neurological injury

BMJ Case Rep, 2020 · DOI: 10.1136/bcr-2020-236131 · Published: October 17, 2020

Neurology Trauma Research Methodology & Design

Simple Explanation

Brown-Séquard syndrome (BSS) is characterized by specific neurological deficits resulting from incomplete spinal cord injury. It typically involves motor function loss, proprioception and vibration sensation on one side of the body, and pain and temperature sensation loss on the opposite side. The case involves a 38-year-old male who sustained a stab wound to the back, leading to the diagnosis of BSS. He underwent surgery to remove the weapon and subsequently underwent rehabilitation, resulting in a near-complete recovery. Despite being rare, BSS serves as a reminder of the spinal cord's anatomy and physiology for trauma providers. Early diagnosis and management are key for good patient outcomes.

Study Duration

Not specified

Participants

A 38-year-old man

Evidence Level

Level 4, Case Report

Key Findings

1
The patient presented with left lower extremity weakness, decreased sensation to light touch, temperature, and vibration on the left side, and decreased sensitivity to touch and temperature on the right lower extremity, consistent with BSS.
2
Postoperative MRI confirmed a hemi-injury to the left side of the spinal cord at the T11 level, along with a fracture of the left T10 lamina and T10-T11 facets.
3
Following rehabilitation, the patient demonstrated considerable recovery in motor function and sensation, eventually being able to ambulate with crutches.

Research Summary

Brown-Séquard syndrome (BSS) presents as an ipsilateral loss of motor function, proprioception and vibratory sensation accompanied by contralateral pain and temperature loss two to three levels below the level of the injury. BSS remains prevalent in areas with high trauma burden, where assaults with sharp weapons are common. We present the case of a man aged 38 years who sustained a stab injury to the left back. BSS was diagnosed. Despite being a rare aetiology, BSS continues to be an excellent reminder to trauma providers of the anatomy and physiology of neuroanatomical tracts.

Practical Implications

Diagnostic Awareness

Maintain a high index of suspicion for BSS in patients with penetrating trauma, especially in areas where sharp weapons are frequently used.

Prompt Management

Early surgical intervention for removal of foreign objects and decompression, followed by rehabilitation, can lead to good outcomes.

Anatomical Understanding

Understanding the anatomical pathways involved in BSS is crucial for accurate diagnosis and appropriate management.

Study Limitations

1
Single case report limits generalizability.
2
Specific clinical presentation deviated slightly from classic BSS, making diagnosis challenging.
3
Lack of detailed long-term follow-up data.

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