What is Brown-Séquard Syndrome?
Brown-Séquard syndrome is a condition that occurs when one side of the spinal cord is partially damaged. This damage can cause weakness or paralysis, loss of awareness of the position and movement of the body parts, and lack of vibration sense on the same side as the damage. Interestingly, the ability to feel pain and changes in temperature is lost on the opposite side of the body. The specific problems a person experiences depend on where and how the injury happened.
Brown-Séquard syndrome is called an incomplete spinal cord syndrome because it doesn’t completely cut off all feeling or movement. This means that the symptoms can vary greatly between individuals. Some might have only minor symptoms, while others could be affected more severely. The severity of the symptoms generally depends on the extent of the spinal cord damage.
What Causes Brown-Séquard Syndrome?
Brown-Séquard syndrome is typically triggered by either a traumatic injury or a non-traumatic event. Traumatic causes are more common and can include gunshot wounds, stab wounds, car accidents, blunt force trauma, or a fractured spine from a fall.
Non-traumatic causes of Brown-Séquard syndrome are less common but can include various conditions like a slipped disc, cysts, cervical spondylosis (neck arthritis), tumors, multiple sclerosis, radiation, and ‘the bends’ experienced by divers. Additional causes might be related to the blood vessels such as a spinal cord hemorrhage (bleeding) or ischemia (restricted blood flow). There are also reported cases where infections, including tuberculosis, transverse myelitis, shingles, empyema, and meningitis have caused the syndrome.
Risk Factors and Frequency for Brown-Séquard Syndrome
Brown-Séquard syndrome is a seldom seen type of partial spinal cord injury, which happens when one side of the spinal cord is harmed. This often takes place in the neck or middle back portion of the spinal cord. It’s important to note that, among all spinal cord injuries, this particular syndrome only makes up 1% to 4% of traumatic injuries.
Signs and Symptoms of Brown-Séquard Syndrome
When examining a patient for a possible spinal injury, it’s very important to take a comprehensive medical history and perform an in-depth physical exam. This will help determine how the injury happened and the severity of the damage, which in turn helps predict potential neurological problems. When taking the medical history, you should consider their surgical history (including spinal surgeries), their existing neurological condition, any past strokes or Parkinson’s disease, and the drugs they’re taking (prescription and over-the-counter medications, as well as alcohol, tobacco, and illegal substances).
A knife wound is the most common cause of traumatic spinal injury. However, other possibilities include a broken bone in the spine, a spinal epidural hematoma, or insufficient blood flow to the spinal cord. These could potentially cause Brown-Séquard syndrome, a specific type of spinal injury that can impair eye, bowel, or bladder function. If the injury occurred in the neck region, it could also have affected the heart and lungs.
The doctor should perform a detailed examination of your motor functions (ability to move) and your sensitivity to touch and temperature. With certain spinal injuries, you might experience the following symptoms:
- Loss of feeling and paralysis on one side of the body at the level of the injury
- Weakness and stiffness in the legs below the level of the injury
- Loss of feeling of pain and temperature on the opposite side of the body, usually a bit higher than the level of the injury
Paralysis might initially appear flaccid (limp) due to shock, so regular check-ups are necessary. If the injury occurred in the upper back or the neck, the doctor should also check for Horner’s syndrome. Horner’s syndrome can display as a smaller pupil, lack of sweating, and a drooping eyelid on one side of the face.
Testing for Brown-Séquard Syndrome
To diagnose Brown-Séquard syndrome (BSS), also known as a type of spinal cord injury, doctors use a combination of neurological examination, identifying the cause of the injury, and imaging tests. Laboratory tests common to most trauma cases, like complete blood count (CBC), comprehensive metabolic panel (CMP), along with measures of clotting time and blood type, are done until a proper diagnosis is definite.
Several imaging tests could be used to understand the exact extent of the injury, which may affect nearby structures or organs. These images can be obtained using techniques such as a chest X-ray or a computed tomography (CT) scan. A CT scan can provide detailed imaging of different body parts like the chest, abdomen, pelvis, head, and the cervical, thoracic, and lumbar spine (the different sections of the spine).
The most detailed information about the spinal injury can be obtained from a Magnetic Resonance Imaging (MRI) scan. An MRI without contrast (a special dye used to highlight areas in the body) of the spinal cord at the injury level can show what caused the injury – whether it was a fluid buildup in the spinal canal, a fracture compressing the spinal cord, or a blockage in blood supply to the spinal cord.
Treatment Options for Brown-Séquard Syndrome
If a person needs it, treatment begins with heart and lung support. Caution should be taken to protect the spine until the injury’s severity and stability are identified. The main aim of further management is to prevent complications. Whether to use steroids, like high-dose intravenous methylprednisolone, in traumatic spinal cord injuries is a topic of debate, as they may increase the risk of infections and other issues without significant improvement in the outcome. However, regular preventive antibiotics before surgery are suggested. Surgery to relieve pressure is considered for those with spinal canal blockage or compression.
For non-surgical treatment, the focus is on helping the person be less dependent in daily life and enhancing their quality of life. This involves a team approach with doctors, nurses, physical therapists, occupational therapists, and social workers who specialize in spinal cord injury. Certain aids such as wheelchairs, braces for limbs, and hand splints can improve the person’s daily life. If the person has trouble breathing or swallowing, various tools can be used. Neck collars can also be used depending on the level of paralysis. If the middle or lower spine is involved, spinal support devices can be used.
What else can Brown-Séquard Syndrome be?
When trying to figure out the cause of a spinal cord injury or compression, doctors need to think about several possible conditions. They need to consider strokes, growths like tumors or cysts, and several spine conditions such as epidural hematoma (bleeding around the spinal cord), epidural abscess (an infection near the spinal cord), syringomyelia (a fluid-filled cavity in the spinal cord), and certain disorders involving the front or center of the spinal cord.
It’s crucial for the health professional to get a thorough medical history from the patient. This can help them understand how the patient’s health and abilities have changed before and after the injury. The timing and nature of new neurological issues (like numbness or weakness) can be crucial clues. For example, if the symptoms appeared suddenly, it’s less likely that the cause is a cyst, tumor, birth defect, or long-term infection.
If the patient’s symptoms are changing in severity and affect different sides of the body at different times, this might suggest a spinal cord disorder where the protective covering of nerve fibers (myelin) is damaged. An example of such a disorder is multiple sclerosis. This condition is more likely to be the cause rather than BSS, a syndrome related to blood flow issues in the spinal cord.
What to expect with Brown-Séquard Syndrome
The outlook for individuals with Brown-Séquard Syndrome (BSS) can vary, depending on the cause of the injury and how much the spinal cord is affected. In general, BSS is considered a type of incomplete spinal cord injury, meaning there’s a good chance for substantial recovery. It’s also worth noting that BSS typically has a better long-term outlook compared to other conditions like anterior and central cord syndrome.
More than half of BSS patients recover well, with most regaining the ability to move after the injury. However, the speed of recovery can slow down between 3 to 6 months, and some neurological recovery might continue for as long as 2 years. Damage to certain nerve fibers usually doesn’t impact bladder and bowel control.
Most patients will regain some strength in their legs, with many being able to walk functionally again.
Possible Complications When Diagnosed with Brown-Séquard Syndrome
Not treating BSS can lead to various problems, including low blood pressure or spinal shock, depression, blood clots in the lungs, and infections that usually occur in the lungs or urinary tract. Patients with severe injuries to the mid- and upper-back and neck require essential breathing support. Other long-term complications like collapsed lung portions, blood clots in deep veins, and pressure sores mainly occur because of limited mobility.
Common complications:
- Low blood pressure or spinal shock
- Depression
- Blood clots in the lungs
- Infections in the lungs or urinary tract
- Collapsed parts of the lung
- Blood clots in deep veins
- Pressure sores
All these complications are mainly due to a lack of movement.
Preventing Brown-Séquard Syndrome
Starting treatment early helps greatly in improving symptoms for most patients, physical therapy and rehabilitation being crucial in this process. BSS (Brown-Sequard Syndrome) has the highest recovery rate when it comes to walking again without assistance amongst all spinal cord injuries. In fact, up to 90% of people can walk unaided after they have rehabilitated. The rehabilitation process typically begins 1 to 2 weeks after the patient’s health condition has stabilized. Recent trends indicate a preference for initiating movement exercises earlier.