BROWN-SEQUARD

SYNDROME
SGD KUB-5
INTRODUCTION
Brown-Squard syndrome is a rare spinal disorder that results from an injury to
one side of the spinal cord in which the spinal cord is damaged but is not severed
completely. It is usually caused by an injury to the spine in the region of the neck
or back.

Characteristically, the affected person loses the sense of touch, vibrations and
position in three dimensions below the level of the injury (hemiparalysis or
asymmetric paresis). The sensory loss is particularly strong on the same side as the
injury to the spine. These sensations are accompanied by a loss of the sense of
pain and of temperature (hypalgesia) on the side of the body opposite to the side
at which the injury was sustained.
DEFINITION

Brown Sequard Syndrome is an incomplete

spinal cord lesion characterized by a clinical
picture reflecting hemisection injury of the
spinal cord, often in the cervical cord region.

Vandenakker-Albanese C. Brown Sequard Syndrome. Medscape [Internet]. 2016 Aug 16; Available from: https://emedicine.medscape.com/article/321652-overview
ETIOLOGY
Brown Sequard Syndrome

any mechanism resulting in damage to one side

of the spinal cord

Traumatic Non Traumatic

Vandenakker-Albanese C. Brown Sequard Syndrome. Medscape [Internet]. 2016 Aug 16; Available from: https://emedicine.medscape.com/article/321652-overview
EPIDEMIOLOGY

Is a rare disorder
True incidence are unknown
Affects males and females in equal
numbers 1
Accounts for 1% to 4% of all traumatic
SCIs 500 cases have been reported to
25000
date.
SCI Cases
PATHOPHYSIOLOGY
DIAGNOSIS AND DIFFERENTIAL DIAGNOSIS
History Taking and
Radiograph Imaging
Physical Examination

Detecting of motor paralysis Spinal Plain Radiograph: detect injury

on ipsilateral side of the in bones (caused by trauma)
lesion MRI: define the extent of spinal cord
Deficit on pain and injury and neurological deterioration
temperature sensation on CT Myelography: when there is a
contralateral side of the contraindication of MRI
lesion

Seon HJ1, Song MK, Han JY, Choi IS, Lee SG. Ann Rehabil Med. 2013. Spontaneous cervical epidural hematoma presenting as brown-sequard syndrome following
repetitive korean traditional deep bows. Feb;37(1):123-6.
Park SD, Kim SW, Jeon I. Korean J Neurotrauma. 2015. Brown-Sequard Syndrome after an Accidental Stab Injury of Cervical Spine: A Case Report. Oct;11(2):180-2.
 As most of the cases are caused by trauma, it is important to make
differential diagnosis with resembling diseases when there is no history
of trauma.

Progressive Spinal
Multiple Sclerosis
Muscular Atrophy

Spinal Cord Injury and

Poliomyelitis
Compression

Guan D, Wang G, Clare M, Kuang Z. J Orthop. 2015. Brown-Sequard syndrome produced by calcified herniated cervical disc and posterior vertebral osteophyte: Case report. Oct
29;12(Suppl 2):S260-3
Previsani N, Tangermann RH, Tallis G, Jafari HS. World Health Organization Guidelines for Containment of Poliovirus Following Type-Specific Polio Eradication - Worldwide, 2015.
MMWR Morb Mortal Wkly Rep. 2015 Aug 28. 64 (33):913-7.
Multiple sclerosis: management of multiple sclerosis in primary and secondary care; NICE clinical guideline (October 2014)
CLINICAL MANIFESTATION
Corticospinal
Dorsal
column
tract Ipsilateral :
spinothalamic Weakness and paralysis due to
tract
corticospinal tract damage
(motorneuron innervating muscle)
Level of lesion
Loses sense of touch, vibrations and
Loss of all proprioception due to dorsal
sensation. Flaccid column damage
paralysis

Contralateral :
Loss sense of pain and of
Loss sense of
temperature usually occurs 2-3
Loss of pain and
touch, segments below the level of the
temperature
vibrations and sensation lesion, because the spinothalamic
proprioception. tract damage
Spastic paralysis
TREATMENT
In Brown Squard Syndrome, there is no specific treatment
to treat the patient.
The treatment in this syndrome is focus to treat the
underlying cause of the syndrome.
Persons with Brown-Squard syndrome regain significant
function, and many medications are not needed long term.
 Nasogastric (NG) tube insertion and subsequent low-wall
suction may help to prevent aspiration. Cervical spine
immobilization, or lower dorsal vertebra immobilization, is
required with trauma or suspicion of an unstable spine.
Hard-collar immobilization may be required if cervical
fracture/injury is identified.
Transfer to a level I trauma center or to a facility with
expertise in the care of spinal cord injuries is appropriate.
The key to successful prehospital care of patients with
Brown-Squard syndrome is to suspect a cervical or
other spinal injury.
One issue with prehospital evaluation of cervical spine
injury is the potential for assumption of a complete
spinal cord lesion rather than an incomplete lesion.
 Physical therapy intervention starts in the acute care
phase of treatment. Physical therapy addresses
mobility issues.
Functional movement starts with bed mobility,
followed by transfers, wheelchair mobility, and, in
many cases of Brown-Squard syndrome, ambulation
Recreational Therapy

Patient with Brown-Sequard

Syndrome may regain more
function/better prognosis than
other patient with Spinal Cord
Injury but consideration of
recreational therapy needs is still
importantto develop their
confidence so they can re-
integration into their society.
Spinal Reduction, Stabilization, and Decompression

Surgical intervention in traumatic SCI has

been controversial. Primally in sugical
intervention focusing on life saving.
Stability may come from direct surgical
repair with bone grafting and
instrumentation or from natural healing or
autofusion in an orthosis. Surgical
decompression of the spinal canal may be
indicated for an incomplete syndrome in
which residual compression is present.
Long Term Monitorinng

Brown-Squard syndrome has a better prognosis that the other

type SCIs, with ongoing neurologic recovery occurring for up to 2
years following the injury. Following achievement of an optimal
functional level, assessment by a physical therapist, occupational
therapist, psychosocial counselor, and therapeutic recreation
specialist is recommended every 1-3 years.
Medication

The use of medication in this

syndrome is very depend on its
etiology and acuity of onset. The
other medication are often use in
this syndrome are used to manage
symptoms and complication are
antibiotic, antispasmodic, pain
medication, and laxatives.
PROGNOSIS AND COMPLICATION OF BROWN-SEQUARD
SYNDROME

Almost 90% of people suffering from Brown-Sequard Syndrome

recover bladder & bowel control and over 80% regain the ability to
walk at least partially.
During the recovery period, patients will experience that they are
recovering from weakness and have better sensory feeling that
occurs in the opposite extremity.
Early and late complications associated with spinal injury may occur.
Patient suffering from Brown-Sequard Syndrome may experience
some complications such as infection, pulmonary embolism, disc
herniation.
CONCLUSION
Brown-Squard syndrome (BSS) is a rare spinal disorder characterized by
hemisectional lesion of spinal cord.
The BSS lesion involved the descending lateral corticospinal tracts, ascending
spinothalamic tract and ascending dorsal column, which results in hemiplegia on one
side of the body and hemianesthesia on the opposite side.

The management of BSS is focused on treating the underlying causes and

supporting the daily living of the patients through physical therapy and supporting
devices. Surgery may be indicated.