Traumatic cervical Brown-Sequard and Brown-Sequard-plus syndromes: the spectrum of presentations and outcomes

Abstract

SummaryBrown-Sequard syndrome (BSS) and Brown-Sequard-plus syndrome (BSPS) are characterised by asymmetrical paresis with hypalgesia more marked on the less paretic side. This study examined the clinical features of 38 patients (30 males and 8 females; mean age =32 years) with traumatic cervical BSS or BSPS who underwent comprehensive in patient rehabilitation. Twenty two injuries were caused by road traffic accidents, 8 by penetrating injuries, 5 by diving injuries, and 3 by other causes. After an average of 35 days in acute care and 79 days in rehabilitation, 37 patients had increased muscle strength, all 38 patients improved functional abilities, 29 patients walked independently, 34 had spontaneous bladder emptying, 36 were discharged home, and 14 were employed. Statistically significant increases (p<O·OOl) were made in modified Barthel index functional scores between admission and discharge. Patients with BSPS had a better prognosis than did those with 'pure' BSS. Patients with predominant upper limb weakness had more favourable outcomes than did those with predominant lower limb weakness. Few other potentially predictive demographic, injury, or neurological factors were associated with functional outcome. Patients with BSS or BSPS generally have a good prognosis for neurological and functional improvement.

Animal Models of Neurologic Disorders: A Nonhuman Primate Model of Spinal Cord Injury

“…This extensive spontaneous increase in corticospinal axon density may in fact be the mechanism that accounts for the marked improvement in function seen in humans after incomplete SCI. Similar to the approximately 50% recovery of hand function observed in this nonhuman primate model of SCI, humans recover locomotor function and partial hand function after Brown-Sequard lesions [51]. In contrast, rats do not recover the ability to grasp food after a SCI hemisection [52].…”

Diffusion tensor imaging and tractography in brown-sequard syndrome

“…2 However, the classical syndrome is rarely seen, and patients often present with only asymmetric paresis and hypalgesia on the less paretic side-termed 'Brown-Sequard plus syndrome' . 3 In the present report, patient 2 presented with the classical syndrome, while patient 1 had features of the 'plus' syndrome. Although a number of aetiologies have been reported, 4 penetrating SCI continues to be a common cause of Brown-Sequard syndrome.…”

“…5 The prognosis in patients with Brown-Sequard syndrome is considered to be better than complete DTI in brown-sequard syndrome A Vedantam et al SCI, while patients with Brown-Sequard plus syndromes tend to have more favorable outcomes as compared to those with the classical syndrome. 3 To the best of our knowledge, only one previous study has documented the role of DTI and DTT in patients with penetrating SCI. 6 In that study, DTI was performed in a single patient with BSS 2 months after a thoracic stab injury.…”

Functional and Anatomical Reorganization of the Sensory-Motor Cortex after Incomplete Spinal Cord Injury in Adult Rats

“…During overground locomotion, ipsilesional forelimbs and hindlimbs showed nearly complete recovery of rhythmicity; the body weight supported by the forelimb was, however, less than in the intact situation. Patients with Brown-Séquard syndrome often regain their ability to walk, with minimal external support, after lesions at either cervical (Taylor and Gleave, 1957;Roth et al, 1991) or thoracic (Little and Halar, 1985) spinal segments. These similarities validated the cervical lateral hemisection injury in rodents as a model for understanding BrownSéquard syndrome in humans.…”