Brown-Sequard Syndrome Flashcards
What is this?
What causes it?
How does it present and how does it relate to the pathophysiology behind it?
How is it managed?
➊ Anatomical disruption of nerve fibre tracts in one half of the spinal cord. There’s disruption to the ascending spinothalamic tracts, ascending dorsal columns (both sensory), and descending lateral corticospinal tracts (motor).
➋ * Trauma, most commonly penetrating injuries e.g. stabbing
* Malignancy
* Disk prolapse
* Infection
* Epidural haematomas
➌ * Dorsal column - This is responsible for fine touch, vibration, two-point discrimination, and proprioception. These sensations would be affected ipsilateral to the lesion because the fibres ascend ipsilaterally before decussating (crossing over) at the lower medulla.
* Spinothalamic tract - This is responsible for pain, temperature, and crude touch. These sensations would be affected contralateral to the lesion because the fibres ascend a level up and then decussate to the opposite side of the cord.
* Corticospinal tract - There would be an ipsilateral loss of movement and paralysis. There would be LMN signs at the level of the lesion, and UMN signs below the lesion. There is no significant motor deficit on the contralateral side.
N.B. Only the spinothalamic tract decussates within the spinal cord itself, leading to the contralateral side being affected.
➍ The need for conservative or surgical management is dependant on the pt’s neurological status and the radiological findings. Surgery is usually indicated in traumatic causes.
