Neuroscience · Year 2 · from Neuroscience
Case 2: Brown-Sequard Syndrome - Spinal Cord Hemisection
Patient Presentation
Demographics: 28-year-old male
Chief Complaint: Weakness of left leg and numbness of right leg after a stabbing injury
History of Present Illness: A 28-year-old man is brought to the emergency department after being stabbed in the back during an altercation. He immediately developed weakness in his left leg and was unable to walk. He also reports numbness in his right leg and "strange sensations" in his left leg. He denies any loss of consciousness or head trauma.
Physical Examination:
- Vital signs: BP 128/78, HR 92, RR 16
- Trauma assessment: 3 cm stab wound over left paravertebral region at approximately T8 level; hemodynamically stable
- Neurological:
- Mental status: Alert, oriented, appropriate
- Cranial nerves: Intact
- Motor: Left lower extremity 2/5 throughout; right lower extremity 5/5; upper extremities normal
- Sensory examination:
- Left side: Loss of vibration sense and proprioception from T8 down; pain and temperature intact
- Right side: Loss of pain and temperature from T10 down (two levels below lesion); light touch and proprioception intact
- Reflexes: Left lower extremity hyperreflexic (3+) with upgoing Babinski; right lower extremity normal (2+)
- Rectal tone: Present
Workup:
- CT spine: Bony structures intact
- MRI thoracic spine: Left hemicord injury at T8 level with cord edema and small hematoma
- CT chest/abdomen: No visceral injury
Diagnosis: Brown-Sequard syndrome (spinal cord hemisection) at T8 level due to penetrating trauma
Treatment:
- Spinal precautions maintained
- Neurosurgical consultation; no surgical intervention indicated as spinal cord injury is complete at the hemi-cord level
- High-dose methylprednisolone controversial and not administered in this case
- DVT prophylaxis (penetrating injury)
- Aggressive physical therapy and rehabilitation
- Significant motor recovery expected given hemisection pattern
Clinical Pearl: Brown-Sequard syndrome demonstrates the anatomical organization of spinal cord tracts. Hemisection causes ipsilateral motor weakness (corticospinal tract), ipsilateral loss of vibration and proprioception (posterior columns), and contralateral loss of pain and temperature (spinothalamic tract, which crosses 1-2 levels above the entry point). Brown-Sequard syndrome has the best prognosis among incomplete spinal cord injuries, with most patients regaining ambulatory function because the contralateral corticospinal tract is preserved.