Brown-Séquard Syndrome as a First Presentation of Multiple Sclerosis

Abstract

A female patient aged 48 years presented with sub-acute onset of weakness in right upper and lower limb over the past one month and numbness over left side of body below neck level. Multiple sclerosis (MS) presenting as Brown-Séquard syndrome is very rare. We present a case of hemicord myelitis which presented as Brown-Séquard syndrome as a first manifestation, which was later diagnosed as MS during subsequent relapses.

Newly Diagnosed Multiple Sclerosis Presenting as Brown-Séquard Syndrome: A Case Report

“…Upon reviewing the literature, we found that MS is one of the rarest known causes of BSS with very few case reports in existence. 1 , 8 , 9 , 10 The exact incidence of BSS due to MS could not be found, likely secondary to its relative rarity. Occasionally, BSS presents as a complication in a patient with known MS, 11 but BSS as an initial presentation is even more rare.…”

“…It is characterized by ipsilateral upper motor neuron motor weakness below the level of lesion, lower motor neuron type at the level of lesion, and loss of ipsilateral proprioception with contralateral loss of pain and temperature sensations below the level of lesion. 1 The syndrome was first described by Charles-Édouard Brown-Séquard in 1849 through his experiments with animal models. 2 Most commonly, BSS is caused by trauma such as stab wounds and is occasionally caused by tumors, with lesser known causes including degenerative diseases, infection, and ischemia.…”

Short-segment myelitis presenting as Brown-Séquard-plus syndrome as the initial attack of multiple sclerosis.

“…Short-segment myelitis (<3 vertebral segments) as the initial attack in multiple sclerosis is uncommon 4 . There are few case reports of Brown-Sequard syndrome as the initial manifestation of multiple sclerosis 5,6,7 . All cases were retrospectively analyzed, because multiple sclerosis diagnosis needs to be constructed with multiple clinical and imaging findings.…”