Brown–Séquard syndrome

Published on 05/05/2015 by admin

Filed under Internal Medicine

Last modified 22/04/2025

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90 Brown–Séquard syndrome

Instruction

Examine this patient’s neurological system.

Salient features

History

• Weak leg that feels normal whereas the other leg is moving perfectly but the patient cannot feel pain and temperature sensation (Fig. 90.1)

• Trauma to the spine, e.g. stab injury

• History of degenerative spine disease or multiple sclerosis

• Tell the examiner you would like also to take a history for bladder and bowel symptoms.

image

Fig. 90.1 Sensory deficit in Brown–Séquard syndrome.

Examination

Deficits below the level of the lesion include:

• Ipsilateral monoplegia or hemiplegia

• Ipsilateral loss of joint position and vibration sense

• Contralateral loss of spinothalamic (pain and temperature) sensation; the latter is sometimes localized to one or two segments below the anatomical level of the lesion.

Deficits in the segment of the lesion:

• Ipsilateral lower motor neuron paralysis

• Ipsilateral zone of cutaneous anaesthesia and a zone hyperaesthesia just below the anaesthetic zone

• Segmental signs such as muscular atrophy, radicular pain or decreased tendon reflexes are usually unilateral.

• Tell the examiner you would like to:

• examine the spine and exclude multiple sclerosis.

Diagnosis

This patient has Brown–Séquard syndrome (or hemisection of the spinal cord) at the level of T8 (lesion) and is probably the result of a compressive or destructive lesion of the spinal cord (aetiology). The patient is limited by the weakness in one limb (functional status).

Advanced-level questions

What are the causes of hemisection of the spinal cord?

• Syringomyelia (p. 280)

• Cord tumour

• Haematomyelia

• Bullet or stab wounds

• Degenerative disease of spine

• Multiple myeloma.

Charles-Edouard Brown-Séquard (1817–1894) was Professor of Physiology in Virginia, USA, at the National Hospital, Queen Square, London, at Harvard, and finally in Paris. He was the first physician-in-chief of the National Hospital in Queen Square, which was founded in 1860. In 1889, he is said to have drawn much attention and criticism for injecting himself with a testicular extract (BMJ 1889;1:1416). Several nations lay claim to Brown–Séquard: he was born in Mauritius, then a British colony, the son of a French woman and an American sea captain (Lancet 2000;356:61–3). He is said to have crossed the Atlantic more than 60 times and set up residence in the USA four times, France six and England once.

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