Spinal cord hemisection (Brown-Séquard syndrome)


Spinal cord hemisection

Causes

  • Trauma (most often penetrating)
  • Epidural hematoma
  • Subdural hematoma
  • Ischemia
  • Herniated disc
  • Spinal cord herniation
  • Hematomyelia
  • Arachnoiditis
  • Tumor (metastatic or primary)
  • Multiple sclerosis
  • Other inflammatory and infectious causes

Clinical presentation

  • Ipsilateral loss of proprioception and vibration sensation.
  • Contralateral loss of pain and temperature sensation that is one or two levels lower than the hemisection
  • Ipsilateral weakness and spasticity with Babinski sign caudal to the level of the hemisection
  • Segmental LMN signs (flaccid weakness and muscle atrophy) at the hemisection level
  • Ipsilateral loss of sweating caudal to hemisection level
  • Horner syndrome if the lesion is cervical
  • Ipsilateral hemidiaphragmatic paralysis if the lesion is high cervical (above C4)