Brown-Sequard syndrome produced by calcified herniated cervical disc and posterior vertebral osteophyte: Case report

Abstract

Brown-Sequard syndrome (BSS) produced by hemisection of the spinal cord will lead to ipsilateral motor weakness, proprioceptive and vibratory sensation loss and is associated with contralateral deficit in sensation of pain and temperature. BSS is most commonly caused by injuries and neoplasms in the cervical and thoracic region.1-5 BSS induced by disc disorders is rare; since the first published case in 1928, only 50 cases have been reported in English language literatures. 6-10This case is the 51st published discogenic BSS, which is produced by calcified herniated C4-C5 disc and posterior vertebral osteophyte. Contrast to previous cases with acute progression, features of BSS took place 7 years after the onset of initial radicular symptom in a quite chronic manner.This 53-year-old male patient had a 7-year history of mild pain and numbness in the left arm. During the 6 months before admission, he had experienced progressive weakness in the left arm and leg, along with contralateral deficit in sensation of pain and temperature below T11.Upon physical examination, features of BSS were shown, including ipsilateral weakness in the left arm and leg (MRC Grade 3/5), hypertonia and hyperreflexia in left lower extremity, as well as reduced contralateral sensation of pain and temperature below T11. In addition, Hoffmann sign, Babinski sign and ankle clonus test of the left side were positive.CT scan showed calcifications of herniated C4-C5 disc and posterior vertebral osteophyte of C5 (Fig. 1). MRI showed a large central left-sided C4-C5 disc herniation, compressing the spinal cord, leading to increased signal intensity on T2WI (Fig. 2). MRI of thoracic spine showed no positive result, eliminating disorders in the thoracic region (Fig. 3). j o u r n a l o f o r t h o p a e d i c s 1 2 ( 2 0 1 5 ) s 2 6 0 -s 2 6 3 a r t i c l e i n f o

Brown-Séquard Syndrome Caused by Acute Traumatic Cervical Disc Herniation

“…The most common causes of BSS are traumatic injury and spinal cord tumor 1 , 10 , 12) . CDH is a relatively rare cause of BSS 3 , 6) and only few reports of BSS caused by CDH have been published until now 9) …”

A Case of a Paracardial Osteophyte Causing Atrial Compression

“…Other rarer complications may result from external compression of the trachea [16, 17], the bronchi [18], the adjacent arteries [19–22], and nerves [23, 24]. Furthermore, chronic throat symptoms [25], back pain [26], Brown-Sequard syndrome [27], Horner syndrome [28], intracranial hypotension [29, 30], chronic obstructive pneumonia [31], traumatic thoracic aortic rupture [32], esophageal perforation [33], and acute urinary retention [34] have been described as osteophytic complications. As far as heart complications are concerned, a traumatic heart perforation [35] and two cases of left atrial deformation by large osteophytes [26, 36] have been so far reported.…”

Nontraumatic Disc Herniation as a Cause of Unusual Cervical Spondylotic Myelopathy

“…Early surgical intervention is positively correlated with better outcomes, most often resulting in significant improvement of symptoms to full recovery. 3,4,6,7,[9][10][11][12] In one case report, surgical intervention did not result in a significant improvement, and the patient had been suffering from progressive symptoms for 7 years prior to diagnosis and treatment. 11 Conservative Management.…”