Brown-Sequard Syndrome - A Rare Neurological Condition

Brown-Sequard Syndrome: Diagnosis, Treatment & Recovery

Brown-Séquard Syndrome is a complex neurological condition that occurs due to damage to one side of the spinal cord. It exhibits a unique pattern of symptoms, including paralysis and loss of proprioception on the affected side.

What are the key symptoms of Brown-Séquard syndrome?

Brown-Séquard syndrome occurs due to a hemisection of the spinal cord, resulting in deficits on one side of the body. Let us discuss some of the key symptoms of Brown-Séquard syndrome:

• Ipsilateral Deficits: Individuals experience a loss of voluntary movement in the affected side of their body. Additionally, they experience difficulty in sensing limb position and movement. The descending motor pathways (corticospinal tracts) are damaged due to paralysis on the same side of the body.
• Contralateral Deficits: Contralateral deficits manifest as a loss of pain and temperature sensation on the opposite side of the body. It occurs because their spinothalamic tract, which carries pain and information about temperature, decussates in their spinal cord and disrupts the whole pathway.
• Muscle Atrophy: Brown-Séquard syndrome can disrupt the communication between the brain and the muscles, leading to denervation atrophy. Over time, disuse atrophy may develop in weakened muscles. However, the primary motor finding is spastic weakness and hyperreflexia due to upper motor neuron damage.
• Horner’s Syndrome: If this syndrome is present in Brown-Séquard syndrome, it indicates an additional injury to the cervical paravertebral sympathetic chain and inferior cervical ganglion. If the spinal cord lesion occurs in the cervical region and affects the T1-T2 spinal segments, it may disrupt the sympathetic nervous system pathways, leading to Horner's syndrome on the ipsilateral side of the face.
   

What Causes Brown-Séquard Syndrome?

Brown-Séquard syndrome can occur due to various factors. Here are some of the common factors that can cause Brown-Séquard syndrome:

• Penetrating Injuries: Any kind of stab wounds, gunshot wounds, and other penetrating injuries to your spine can cause BSS.
• Blunt Trauma: Motor vehicle accidents, falls, or any other types of blunt trauma can damage the spinal cord, leading to the development of BSS.
• Spinal Cord Tumours: Tumours in your spinal cord can compress the spinal cord and lead to the development of Brown-Séquard syndrome.
• Infectious diseases: Certain conditions, like transverse myelitis, tuberculosis, and meningitis, can affect the spinal cord.
   

What are the treatments for Brown-Séquard syndrome?

The treatment for BSS involves medications, surgery, and rehabilitation therapies, as it focuses on addressing the underlying causes. Let us discuss some treatment approaches for BSS:

• Surgery: For non-traumatic cases, surgery may help to relieve pressure on the spinal cord, such as for tumours or herniated discs.
• Medications: Doctors recommend steroids to reduce inflammation and swelling, especially in the early stages, but the use of high-dose steroids in traumatic spinal cord injury is controversial and not routinely recommended due to limited evidence of long-term benefit and significant potential risks.
• Disease-Specific Therapy: Treating the underlying cause is paramount. This includes antibiotics for bacterial infections, antivirals for viral infections and immunotherapy (e.g., steroids, plasma exchange) for inflammatory or demyelinating causes (e.g., multiple sclerosis, transverse myelitis).
   

Individuals suffering from BSS must consult with healthcare providers to treat the issues as early as possible. If they are left untreated, it can lead to serious complications at a later stage.