Brown-Séquard syndrome is an incomplete spinal cord lesion reflecting hemi section injury in the cervical region.
It causes ipsilateral paralysis, proprioception loss, and contralateral pain. Partial preservation zone shows ipsilateral weakness and analgesia noted.
The symptoms vary from mild to severe neurologic deficits. Pure Brown-Séquard syndrome from cord hemisection is rare.
A clinical picture with syndrome fragments and extra symptoms is more frequently observed.
Interruption of corticospinal tracts causes a spastic weak leg with brisk reflexes, while the strong leg loses pain and temperature sensation.
It is diagnosed through history and physical examination. Laboratory work is not essential for evaluation but helps in tracking patient progress.
The clinical presentation relates to spinal cord anatomy and corticospinal tract motor fibers cross at medulla-spinal junction.
The ascending dorsal column transmits vibration and position sensations and crossing in the medulla.
Epidemiology
Brown-Séquard syndrome is rare accounts for 2-4% of the estimated 17,800 traumatic spinal cord injuries annually in the United States.
Incomplete tetraplegia prevalence in 1649 individuals as 30%, 10%, and 3% respectively.
Since 2015, spinal cord injury cases are 59% white, 23.9% African American, 12.8% Hispanic, and 1.4% other ethnicities.
Demographic studies indicate a higher incidence of spinal cord injuries in males compared to females due to traumatic causes.
SCI predominantly affects individuals aged 16-30 with mean age rising in recent decades.
Anatomy
Pathophysiology
It arises from unilateral damage to spinal cord ascending and descending tracts.
Petechial hemorrhages in gray matter enlarge within an hour occurs hemorrhagic necrosis in 24-36 hours. White matter exhibits hemorrhage and structural damage in myelinated fibres.
Saadon-Grosman studied two patient groups those with cervical sensory Brown-Séquard syndrome and those undergoing cervical disk repair.
Etiology
Brown-Séquard syndrome results from damage to one side of spinal cord.
Traumatic injuries, stab or gunshot wounds, or unilateral facet fractures from vehicle accidents or falls are the most common causes.
Unusual causes reported include pen assault, cerebrospinal fluid catheter removal post-surgery, and blowgun dart injury.
Genetics
Prognostic Factors
It shows good prognosis for motor recovery, with significant improvement in 1-2 months post-injury
Recovery slows after initial phase but may continue for 2 years post-injury.
Pollard and Apple’s review of 412 traumatic cervical SCI patients revealed completeness of the lesion as key for neurologic recovery.
Recovery in patients with stenosis without fracture was unrelated to high-dose steroids or routine surgical intervention.
Clinical History
Collect details including presenting symptom, onset and progression and medical history to understand clinical history of patient.
Physical Examination
Motor Examination
Sensory Examination
Gait and Coordination
Autonomic Function
Age group
Associated comorbidity
Associated activity
Acuity of presentation
Acute symptoms are:
Stab wounds, gunshot injurie, spinal cord infarction, motor weakness and sensory disturbances
Preparing a life-care plan for Brown-Séquard syndrome patients requires special attention due to the syndrome’s incompleteness and uncertain lifetime needs.
Maximal function evaluation should consider difficulties and changes of aging with disability.
Address secondary complications with aggressive prevention and early treatment.
Transfer to a level I trauma centre for spinal cord injury care is appropriate but should not delay overall patient evaluation for additional injuries.
Emergency department care involves thorough evaluation, neurological examination, and careful immobilization of the cervical and dorsal spine to prevent movement.
Sensory loss complicates injury investigation, and supplementary imaging studies for clarity.
Neurologic recovery post-discharge warrants continued outpatient physical therapy.
Surgical intervention in traumatic SCI emphasizes spinal stability and prompt reduction of spinal deformity.
The reduced spine’s stabilization to prevent cord injury is controversial; options include surgical repair with grafting and instrumentation or natural healing in an orthosis.
Surgical decompression of spinal canal may help with residual compression.
use-of-phases-in-managing-brown-sequard-syndrome
In the acute diagnosis phase, the goal is to stabilize the patient, prevent further spinal cord injury, and diagnose and treat the underlying cause.
Pharmacologic therapy is effective in the treatment phase as it includes the use of corticosteroids.
In supportive care and management phase, patients should receive required attention such as lifestyle modification and surgical interventional therapies.
The regular follow-up visits with the physician are scheduled to check the improvement of patients along with treatment response.
Brown-Séquard syndrome is an incomplete spinal cord lesion reflecting hemi section injury in the cervical region.
It causes ipsilateral paralysis, proprioception loss, and contralateral pain. Partial preservation zone shows ipsilateral weakness and analgesia noted.
The symptoms vary from mild to severe neurologic deficits. Pure Brown-Séquard syndrome from cord hemisection is rare.
A clinical picture with syndrome fragments and extra symptoms is more frequently observed.
Interruption of corticospinal tracts causes a spastic weak leg with brisk reflexes, while the strong leg loses pain and temperature sensation.
It is diagnosed through history and physical examination. Laboratory work is not essential for evaluation but helps in tracking patient progress.
The clinical presentation relates to spinal cord anatomy and corticospinal tract motor fibers cross at medulla-spinal junction.
The ascending dorsal column transmits vibration and position sensations and crossing in the medulla.
Brown-Séquard syndrome is rare accounts for 2-4% of the estimated 17,800 traumatic spinal cord injuries annually in the United States.
Incomplete tetraplegia prevalence in 1649 individuals as 30%, 10%, and 3% respectively.
Since 2015, spinal cord injury cases are 59% white, 23.9% African American, 12.8% Hispanic, and 1.4% other ethnicities.
Demographic studies indicate a higher incidence of spinal cord injuries in males compared to females due to traumatic causes.
SCI predominantly affects individuals aged 16-30 with mean age rising in recent decades.
It arises from unilateral damage to spinal cord ascending and descending tracts.
Petechial hemorrhages in gray matter enlarge within an hour occurs hemorrhagic necrosis in 24-36 hours. White matter exhibits hemorrhage and structural damage in myelinated fibres.
Saadon-Grosman studied two patient groups those with cervical sensory Brown-Séquard syndrome and those undergoing cervical disk repair.
Brown-Séquard syndrome results from damage to one side of spinal cord.
Traumatic injuries, stab or gunshot wounds, or unilateral facet fractures from vehicle accidents or falls are the most common causes.
Unusual causes reported include pen assault, cerebrospinal fluid catheter removal post-surgery, and blowgun dart injury.
It shows good prognosis for motor recovery, with significant improvement in 1-2 months post-injury
Recovery slows after initial phase but may continue for 2 years post-injury.
Pollard and Apple’s review of 412 traumatic cervical SCI patients revealed completeness of the lesion as key for neurologic recovery.
Recovery in patients with stenosis without fracture was unrelated to high-dose steroids or routine surgical intervention.
Collect details including presenting symptom, onset and progression and medical history to understand clinical history of patient.
Motor Examination
Sensory Examination
Gait and Coordination
Autonomic Function
Acute symptoms are:
Stab wounds, gunshot injurie, spinal cord infarction, motor weakness and sensory disturbances
Preparing a life-care plan for Brown-Séquard syndrome patients requires special attention due to the syndrome’s incompleteness and uncertain lifetime needs.
Maximal function evaluation should consider difficulties and changes of aging with disability.
Address secondary complications with aggressive prevention and early treatment.
Transfer to a level I trauma centre for spinal cord injury care is appropriate but should not delay overall patient evaluation for additional injuries.
Emergency department care involves thorough evaluation, neurological examination, and careful immobilization of the cervical and dorsal spine to prevent movement.
Sensory loss complicates injury investigation, and supplementary imaging studies for clarity.
Neurologic recovery post-discharge warrants continued outpatient physical therapy.
Physical Medicine and Rehabilitation
Install ramps or stairlifts for wheelchair access in multi-level areas.
Position near toilets and showers for support also use a bench or chair to enhance safety during bathing.
Adjust counter heights and keep frequently used items accessible for sitting tasks.
Utilize raised dots on switches and install anti-scald devices in showers to prevent burns.
Proper awareness about Brown-Sequard Syndrome should be provided and its related causes with management strategies.
Appointments with physician and preventing recurrence of disorder is an ongoing life-long effort.
Physical Medicine and Rehabilitation
Methylprednisolone:
It decreases inflammation to suppress migration of polymorphonuclear leukocytes.
High-dose steroids administered early improve outcomes for traumatic spinal cord injury patients.
Corticosteroids possess anti-inflammatory properties and significantly changes the body’s metabolic responses.
Physical Medicine and Rehabilitation
Surgical intervention in traumatic SCI emphasizes spinal stability and prompt reduction of spinal deformity.
The reduced spine’s stabilization to prevent cord injury is controversial; options include surgical repair with grafting and instrumentation or natural healing in an orthosis.
Surgical decompression of spinal canal may help with residual compression.
Physical Medicine and Rehabilitation
In the acute diagnosis phase, the goal is to stabilize the patient, prevent further spinal cord injury, and diagnose and treat the underlying cause.
Pharmacologic therapy is effective in the treatment phase as it includes the use of corticosteroids.
In supportive care and management phase, patients should receive required attention such as lifestyle modification and surgical interventional therapies.
The regular follow-up visits with the physician are scheduled to check the improvement of patients along with treatment response.
Brown-Séquard syndrome is an incomplete spinal cord lesion reflecting hemi section injury in the cervical region.
It causes ipsilateral paralysis, proprioception loss, and contralateral pain. Partial preservation zone shows ipsilateral weakness and analgesia noted.
The symptoms vary from mild to severe neurologic deficits. Pure Brown-Séquard syndrome from cord hemisection is rare.
A clinical picture with syndrome fragments and extra symptoms is more frequently observed.
Interruption of corticospinal tracts causes a spastic weak leg with brisk reflexes, while the strong leg loses pain and temperature sensation.
It is diagnosed through history and physical examination. Laboratory work is not essential for evaluation but helps in tracking patient progress.
The clinical presentation relates to spinal cord anatomy and corticospinal tract motor fibers cross at medulla-spinal junction.
The ascending dorsal column transmits vibration and position sensations and crossing in the medulla.
Brown-Séquard syndrome is rare accounts for 2-4% of the estimated 17,800 traumatic spinal cord injuries annually in the United States.
Incomplete tetraplegia prevalence in 1649 individuals as 30%, 10%, and 3% respectively.
Since 2015, spinal cord injury cases are 59% white, 23.9% African American, 12.8% Hispanic, and 1.4% other ethnicities.
Demographic studies indicate a higher incidence of spinal cord injuries in males compared to females due to traumatic causes.
SCI predominantly affects individuals aged 16-30 with mean age rising in recent decades.
It arises from unilateral damage to spinal cord ascending and descending tracts.
Petechial hemorrhages in gray matter enlarge within an hour occurs hemorrhagic necrosis in 24-36 hours. White matter exhibits hemorrhage and structural damage in myelinated fibres.
Saadon-Grosman studied two patient groups those with cervical sensory Brown-Séquard syndrome and those undergoing cervical disk repair.
Brown-Séquard syndrome results from damage to one side of spinal cord.
Traumatic injuries, stab or gunshot wounds, or unilateral facet fractures from vehicle accidents or falls are the most common causes.
Unusual causes reported include pen assault, cerebrospinal fluid catheter removal post-surgery, and blowgun dart injury.
It shows good prognosis for motor recovery, with significant improvement in 1-2 months post-injury
Recovery slows after initial phase but may continue for 2 years post-injury.
Pollard and Apple’s review of 412 traumatic cervical SCI patients revealed completeness of the lesion as key for neurologic recovery.
Recovery in patients with stenosis without fracture was unrelated to high-dose steroids or routine surgical intervention.
Collect details including presenting symptom, onset and progression and medical history to understand clinical history of patient.
Motor Examination
Sensory Examination
Gait and Coordination
Autonomic Function
Acute symptoms are:
Stab wounds, gunshot injurie, spinal cord infarction, motor weakness and sensory disturbances
Preparing a life-care plan for Brown-Séquard syndrome patients requires special attention due to the syndrome’s incompleteness and uncertain lifetime needs.
Maximal function evaluation should consider difficulties and changes of aging with disability.
Address secondary complications with aggressive prevention and early treatment.
Transfer to a level I trauma centre for spinal cord injury care is appropriate but should not delay overall patient evaluation for additional injuries.
Emergency department care involves thorough evaluation, neurological examination, and careful immobilization of the cervical and dorsal spine to prevent movement.
Sensory loss complicates injury investigation, and supplementary imaging studies for clarity.
Neurologic recovery post-discharge warrants continued outpatient physical therapy.
Physical Medicine and Rehabilitation
Install ramps or stairlifts for wheelchair access in multi-level areas.
Position near toilets and showers for support also use a bench or chair to enhance safety during bathing.
Adjust counter heights and keep frequently used items accessible for sitting tasks.
Utilize raised dots on switches and install anti-scald devices in showers to prevent burns.
Proper awareness about Brown-Sequard Syndrome should be provided and its related causes with management strategies.
Appointments with physician and preventing recurrence of disorder is an ongoing life-long effort.
Physical Medicine and Rehabilitation
Methylprednisolone:
It decreases inflammation to suppress migration of polymorphonuclear leukocytes.
High-dose steroids administered early improve outcomes for traumatic spinal cord injury patients.
Corticosteroids possess anti-inflammatory properties and significantly changes the body’s metabolic responses.
Physical Medicine and Rehabilitation
Surgical intervention in traumatic SCI emphasizes spinal stability and prompt reduction of spinal deformity.
The reduced spine’s stabilization to prevent cord injury is controversial; options include surgical repair with grafting and instrumentation or natural healing in an orthosis.
Surgical decompression of spinal canal may help with residual compression.
Physical Medicine and Rehabilitation
In the acute diagnosis phase, the goal is to stabilize the patient, prevent further spinal cord injury, and diagnose and treat the underlying cause.
Pharmacologic therapy is effective in the treatment phase as it includes the use of corticosteroids.
In supportive care and management phase, patients should receive required attention such as lifestyle modification and surgical interventional therapies.
The regular follow-up visits with the physician are scheduled to check the improvement of patients along with treatment response.
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