Acute Partial Brown-Séquard Syndrome Secondary to Intraforaminal Disc Prolapse and Spinal Cord Infarction

Abstract

We report the case of a 45-year-old female who presented with acute left abdominal pain and subsequently developed a left partial Brown-Séquard syndrome. Spinal fluid, inflammatory and prothrombotic tests were unremarkable. Magnetic resonance showed a left intraforaminal disc prolapse at the T9–T10 level and a hyperintense lesion on T2-weighted images in the left postero-lateral cord at the T8–T9 level with restricted diffusion on DWI imaging. A diagnosis of spinal cord infarction due to compromise of the left T8 thoracic radicular artery was made. The patient was managed conservatively and at the 3 months follow-up, she was ambulant and able to walk small distances without a walker.

Spinal cord ischemia revealed by a Brown-Sequard syndrome and caused by a calcified thoracic disc extrusion with spontaneous regression: a case report and review of the literature

“…The syndrome is more often caused by traumatic medullary injuries and extramedullary spinal cord tumors [ 5 ]. Only a few cases of spinal cord ischemia presenting as a Brown-Sequard syndrome were reported in the literature, following dissection of the vertebral arteries at the cervical level [ 6 , 7 ] or arterial compression by disc herniation at the thoracic level [ 2 , 3 ]. In our patient, the disc herniation was later recognized as the underlying cause of the ischemia, following a negative vascular workup.…”

“…The posterior spinal artery syndrome is relatively infrequent, while total transverse spinal cord ischemia involving both anterior and posterior spinal arteries has rarely been described. Brown-Sequard syndromes are thought to arise from the involvement of a single sulco-commissural artery [ 2 ].…”

“…FCE is a rare cause of spinal cord and cerebral ischemia, whose definite diagnosis relies on autopsy. Most cases of FCE have been found associated with physical exertion, minor trauma or Valsalva maneuver before severe spinal cord infarction [ 2 , 9 ]. In our case, the physical exercise preceding the symptom onset likely caused the rupture of the nucleus pulposus and subsequent herniation.…”

“…Common causes include atherosclerosis, cardioembolism, aortic dissection or surgery [ 1 ]. Rare cases of spinal cord ischemia related to disc herniation have been reported in the literature including two cases revealed by a Brown-Sequard syndrome [ 2 , 3 ]. Differential diagnosis with a compressive myelopathy caused by the disc herniation can be difficult and therapeutic management is controversial.…”

Non-traumatic Causes of Brown-sequard Syndrome: A Case Series and Clinical Update With Systematic Review

“…Spinal cord ischemia, usually followed by infarction, occurs due to diminished blood supply to the spinal cord. The causes of blood supply cessation include compression on the blood vessels supplying the spinal cord by tumors or hernias, circulating thrombi, or iatrogenically following endovascular embolization of vertebral hemangioma [29][30][31][32]. The treatment is usually conservative with anticoagulation and antiplatelets [31].…”