Overview of Brown-Sequard Syndrome.

  • Evelyn Sharon
  • RNP Keerthanashree
Keywords: Spinal cord injury, Sensory function, Motor function, BBrown-Séquard syndrome, Neurologic syndrome

Abstract

A neurologic syndrome called Brown-Séquard syndrome is brought on by spinal cord hemisection. On the side of the body, ipsilateral to the lesion, it presents as weakness or paralysis, proprioceptive abnormalities, and loss of pain and temperature perception. Brown-Séquard syndrome is an incomplete spinal cord syndrome with a range of severity in its clinical presentation.

     One of the most intricate and fascinating areas of the nervous system to study is the spinal cord. Its overwhelming clinical presentation, development problems, lesions, and intricate connections call for a deeper comprehension of its anatomical and physiological makeup.

     Like the brain, the extremely fragile and sensitive spinal cord is well-protected by the robust bony cage comprising the vertebral arch and vertebral bodies. Together, they create the spinal hollow, or long spinal column, which houses the spinal cord. Millions of neurons reside in the spinal cord, and their bundled fibers run as ascending or descending tracts. Thirty-one pairs of spinal nerves, primarily supplying the trunk and limbs, emerge from the spinal cord. These are mixed spinal nerves with a motor component that assists in controlling the trunk and voluntary muscles in all limbs. Additionally, they have a sensory component that aids in taking in the sensory data from these regions. Therefore, for a better understanding of the clinical presentation and its pathology in any spinal cord lesion, it is imperative to grasp the fundamentals of anatomy.

      In this short review, we have discussed the symptoms, management, and prevention of brown syndrome.

References

Rengachary SS, Colen C, Guthikonda M. Charles-Edouard Brown-Séquard: an eccentric genius. Neurosurgery, 2008; 62(4):954-64; 964. doi: 10.1227/01.neu.0000318182.87664.1f

Brown-Sequard Syndrome. National Institute of Neurological Disorders and Stroke (nih.gov), https://www.ninds.nih.gov/health-information/disorders/brown-sequard-syndrome#:~:text=Brown%2DSequard%20syndrome%20(BSS),sensation%20on%20the%20opposite%20side.

Spinal cord injury - Symptoms and causes - Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/spinal-cord-injury/symptoms-causes/syc-20377890.

Shams S, Arain A. Brown Sequard Syndrome. [Updated 2020 Sep 14]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing, 2021.

Jain NB, Ayers GD, Peterson EN, Harris MB, Morse L, O'Connor KC, Garshick E. Traumatic spinal cord injury in the United States, 1993-2012, JAMA, 2015, 09;313(22):2236-43. doi:10.1001/jama.2015.6250.

Halvorsen A, Pettersen AL, Nilsen SM, Halle KK, Schaanning EE, Rekand T. Epidemiology of traumatic spinal cord injury in Norway in 2012-2016: a registry-based cross-sectional study. Spinal Cord. 2019; 57(4):331-338. doi: 10.1038/s41393-018-0225-5.

Spinal cord injury: Symptoms, treatment, and causes. https://www.medicalnewstoday.com/

Boonpirak N, Apinhasmit W. Length and caudal level of termination of the spinal cord in Thai adults. Acta Anat (Basel). 1994;149(1):74-8. doi: 10.1159/000147558

Bhat AR, Kirmani AR, Wani MA, Bhat MH. Incidence, histopathology, and surgical outcome of tumors of the spinal cord, nerve roots, meninges, and vertebral column - Data based on single institutional (Sher-i-Kashmir Institute of Medical Sciences) experience. J Neurosci Rural Pract. 2016 Jul-Sep;7(3):381-91. doi: 10.4103/0976-3147.181489.

Bican O, Minagar A, Pruitt AA. The spinal cord: a review of functional neuroanatomy. Neurol Clin. 2013;31(1):1-18. doi: 10.1016/j.ncl.2012.09.009.

Boonpirak N, Apinhasmit W. Length and caudal level of termination of the spinal cord in Thai adults. Acta Anat (Basel). 1994;149(1):74-8. doi: 10.1159/000147558

Ko HY, Park JH, Shin YB, Baek SY. Gross quantitative measurements of spinal cord segments in humans. Spinal Cord. 2004;42(1):35-40. doi:10.1038/sj.sc.3101538

Harrow-Mortelliti M, Reddy V, Jimsheleishvili G. Physiology, Spinal Cord. [Updated 2023 Mar 17]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024. https://www.ncbi.nlm.nih.gov/books/NBK544267/

Mercadante AA, Tadi P. StatPearls. StatPearls Publishing; Treasure Island (FL): 24, 2023. Neuroanatomy, Gray Matter.

Petkó M, Antal M. Propriospinal pathways in the dorsal horn (laminae I-IV) of the rat lumbar spinal cord. Brain Res Bull. 2012;89(1-2):41-9. doi:10.1016/j.brainresbull.2012.06.005

Krotov V, Tokhtamysh A, Kopach O, Dromaretsky A, Sheremet Y, Belan P, Voitenko N. Functional Characterization of Lamina X Neurons in ex-Vivo Spinal Cord Preparation. Front Cell Neurosci. 2017;11:342. doi:10.3389/fncel.2017.00342

Cho TA. Spinal cord functional anatomy. Continuum (Minneap Minn). 2015;21(1 Spinal Cord Disorders):13-35.

doi:10.1212/01.CON.0000461082.25876.4a

Bican O, Minagar A, Pruitt AA. The spinal cord: a review of functional neuroanatomy. Neurol Clin. 2013;31(1):1-18. doi:10.1016/j.ncl.2012.09.009

Honey CM, Ivanishvili Z, Honey CR, Heran MKS. Somatotopic organization of the human spinothalamic tract: in vivo computed tomography-guided mapping in awake patients undergoing cordotomy. J Neurosurg Spine. 2019;1-7. doi:10.3171/2018.11. SPINE18172

Sakai N, Insolera R, Sillitoe RV, Shi SH, Kaprielian Z. Axon sorting within the spinal cord marginal zone via Robo-mediated inhibition of N-cadherin controls spinocerebellar tract formation. J Neurosci. 2012;32(44):15377-87. doi:10.1523/JNEUROSCI.2225-12.2012

Chen YT, Li S, Zhou P, Li S. A startling acoustic stimulation (SAS)-TMS approach to assess the reticulospinal system in healthy and stroke subjects. J Neurol Sci. 2019; 399:82-88. doi:10.1016/j.jns.2019.02.018

Frostell A, Hakim R, Thelin EP, Mattsson P, Svensson M. A Review of the Segmental Diameter of the Healthy Human Spinal Cord. Front Neurol. 2016; 7:238.

doi:10.3389/fneur.2016.00238

Torlincasi AM, Waseem M. Cervical Injury. [Updated 2022 Aug 22]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024. https://www.ncbi.nlm.nih.gov/books/NBK448146/

Spinal cord injury - Symptoms and causes - Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/spinal-cord-injury/symptoms-causes/syc-20377890

Tetraplegia: Definition, Causes, and Treatments https://www.healthline.com/health/tetraplegia

Thoracic Spinal Cord Injury, SpinalCord.com. https://www.spinalcord.com/thoracic-spinal-cord-injury

Paraplegia: Definition, Causes, Symptoms, Types & Treatment; clevelandclinic.org. https://my.clevelandclinic.org/health/symptoms/23984-paraplegia

Lumbar Spinal Cord Injury: Understanding L1, L2, L3, L4, L5 SCI, flintrehab.com. https://www.flintrehab.com/lumbar-spine-injury/

Sacral Spine (S1 - S5) Injuries, Sacral Sparing | SpinalCord.com. https://www.spinalcord.com/sacral-spine-s1-s5-vertebrae-injuries-sacral-sparing

Musker P, Musker G. Pneumocephalus and Brown-Séquard syndrome caused by a stab wound to the back. Emerg Med Australas. 2011;23(2):217–19. doi: 10.1111/j.1742-6723.2011. 01402.x

Urrutia J, Fadic R. Cervical disc herniation producing acute Brown-Séquard syndrome: Dynamic changes documented by intraoperative neuromonitoring. Eur Spine J. 2012;21(4):418–21. doi:10.1007/s00586-011-1881-8

Shams S, Arain A. StatPearls [Internet]. StatPearls Publishing; Treasure Island (FL), 2022. Brown-Sequard Syndrome.

Shams S, Arain A. Brown-Sequard Syndrome. [Updated 2022 Sep 12]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK538135/

Kashyap S, Majeed G, Lawandy S. A rare case of Brown-Sequard syndrome caused by traumatic cervical epidural hematoma. Surg Neurol Int. 2018;9:213. doi:10.4103/sni.sni_142_18

Zeng Y, Ren H, Wan J, Lu J, Zhong F, Deng S. Cervical disc herniation causing Brown-Sequard syndrome: Case report and review of the literature (CARE-compliant). Medicine (Baltimore). 2018;97(37):

e12377.

Zhang XY, Yang YM. Scissors stab wound to the cervical spinal cord at the craniocervical junction. Spine J. 2016;16(6): e403-6. doi:10.1016/j.spinee.2016.01.189

Tseng WS, Huang NC, Huang WS, Lee HC. Brown-Séquard syndrome: a rare manifestation of decompression sickness. Occup Med (Lond). 2015;65(9):758-60. doi:10.1093/occmed/kqv145

Tseng WS, Huang NC, Huang WS, Lee HC. Brown-Séquard syndrome: a rare manifestation of decompression sickness. Occup Med (Lond). 2015;65(9):758-60. doi:10.1093/occmed/kqv145

Ameer MA, Tessler J, Munakomi S, Gillis CC. StatPearls [Internet]. StatPearls Publishing; Treasure Island (FL), 2023. Central Cord Syndrome.

Silva Macedo Y, Dos Santos Mota A, Morais Monteiro P, Carvalho AC, Fernandes Diniz B, Gemal Lanzieri P, Carneiro Ramos R, Mocarzel LO, Gismondi RA. Posterior Cord Syndrome and Trace Elements Deficiency as an Uncommon Presentation of Common Variable Immunodeficiency. Case Rep Med. 2017; 2017:9870305.

doi:10.1155/2017/9870305

Pearl NA, Dubensky L. StatPearls. StatPearls Publishing; Treasure Island (FL), 2022. Anterior Cord Syndrome. https://www.ncbi.nlm.nih.gov/books/NBK559117/

Shams S, Arain A. StatPearls. StatPearls Publishing; Treasure Island (FL), 2022. Brown-Sequard Syndrome.

Nene Y, Jilani TN. StatPearls. StatPearls Publishing; Treasure Island (FL), 2023. Neuroanatomy, Conus Medullaris.

Berg EJ, Ashurst JV. StatPearls [Internet]. StatPearls Publishing; Treasure Island (FL), 2023. Anatomy, Back, Cauda Equina.

Spinal cord injury: Symptoms, treatment, and causes, medicalnewstoday.com. https://www.medicalnewstoday.com/articles/spinal-cord-injuries

Hachem LD, Ahuja CS, Fehlings MG. Assessment and management of acute spinal cord injury: From point of injury to rehabilitation. J Spinal Cord Med. 2017;40(6):665-675. doi: 10.1080/10790268.2017.1329076

Lee DY, Park YJ, Song SY, Hwang SC, Kim KT, Kim DH. The Importance of Early Surgical Decompression for Acute Traumatic Spinal Cord Injury. Clin Orthop Surg. 2018;10(4):448-454.

doi: 10.4055/cios.2018.10.4.448

Gaillard F, Ghimire P, Sharma R, et al. Brown-Séquard syndrome. Reference article, Radiopaedia.org (Accessed on 13 Mar 2024). doi.org/10.53347/rID-30911

Patel DM, Weinberg BD, Hoch MJ. CT Myelography: Clinical Indications and Imaging Findings. Radiographics. 2020; 40(2):470-484.

doi: 10.1148/rg.2020190135.

Brown-Sequard syndrome: causes symptoms, treatment, and more (webmd.com). https://www.webmd.com/brain/what-is-brown-sequard-syndrome

Ranga U, Aiyappan SK, Brown – Sequard syndrome.The Indian Journal of Medical Research. 2014; 140(4): 572 – 573.

Vandenkker – Albanese c, Brown – Sequard syndrome [ Internet]. 2020 [ cited 20 May 2021]. Available from; https://emedicine.medscape.com/article/321652-overview

Toluse A, Adeyemi T, Angaye E, Alimi M. Brown-squad Niger J Orthop Trauma 2020;19:77-9.

Thompson AJ, McSwain SD, Webb SA, Stroud MA, Streck CJ. Venous thromboembolism prophylaxis in the pediatric trauma population. J Pediatr Surg. 2013; 48:1413–21. Available from: http://www.ncbi.nlm.nih.gov/pubmed/23845640

Jones T, Ugalde V, Franks P, Zhou H, White RH. Venous thromboembolism after spinal cord injury: incidence, time course, and associated risk factors in 16,240 adults and children. Arch Phys Med Rehabil. 2005; 86:2240–7. http://www.ncbi.nlm.nih.gov/pubmed/16344018

Al-Otaibi YK, Al-Nowaiser N, Rahman A. Reducing hospital-acquired pressure injuries. BMJ Open Qual. 2019 Feb 13;8(1):e000464. doi: 10.1136/bmjoq-2018-000464. PMID: 30997418; PMCID: PMC6440606.

Karthikumar B, Keshava SN, Moses V, Chiramel GK, Ahmed M, Mammen S. Percutaneous gastrostomy placement by intervention radiology: Techniques and outcome. Indian J Radiol Imaging. 2018;28(2):225-231. doi: 10.4103/ijri.IJRI_393_17.

Beach EC, De Jesus O. Ileus. [Updated 2023 Aug 23]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024. https://www.ncbi.nlm.nih.gov/books/NBK558937/

Conscious Breathing: Benefits, Types, How to Practice, Safety (healthline.com). https://www.healthline.com/health/mind-body/conscious-breathing

Leslie SW, Tadi P, Tayyeb M. Neurogenic Bladder and Neurogenic Lower Urinary Tract Dysfunction. [Updated 2023 Jul 4]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024. https://www.ncbi.nlm.nih.gov/books/NBK560617/

Allen KJ, Leslie SW. Autonomic Dysreflexia. [Updated 2023 May 30]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024. https://www.ncbi.nlm.nih.gov/books/NBK482434/

Haines, DE. (2004) Ch 5: Internal Morphology of the Spinal Cord and Brain in Stained Sections. Neuroanatomy: An Atlas of Structures, Sections, and Systems (6th ed).

Published
2024-04-16
How to Cite
Sharon, E., & Keerthanashree, R. (2024). Overview of Brown-Sequard Syndrome. Journal of Internal Medicine: Science & Art, 5, 10 -20. https://doi.org/10.36013/jimsa.v5i.134
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Articles