The Brown Sequard syndrome it is a rare neurological disease characterized by the presence of a spinal cord injury. Clinically, this syndrome is defined by the development of muscle weakness, variable paralysis, or loss of sensation in different areas of the body. All these characteristics are due to the presence of an incomplete section or hemisection of the spinal cord, especially in the cervical regions..
The etiological causes of Brown Sequard syndrome and spinal cord injuries are often varied. Some of the most common are related to tumor formations, trauma, ischemic processes, infectious diseases or other demilinizing diseases, such as multiple sclerosis..
Most commonly, this syndrome presents as a sequel to a traumatic injury to the spinal cord. Given the characteristic clinical findings related to motor and sensory functions, it is essential to perform diagnostic imaging tests to confirm and identify the location of the spinal cord injury..
The medical prognosis of the affected person varies depending on the delay time of diagnosis and the therapeutic choice. The most common is to use a surgical repair approach.
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This syndrome was initially described in 1849 by the researcher Edouard Brown-Sequard. These first descriptions referred to a spinal hemisection resulting from an injury with a cutting weapon..
The patient's clinical characteristics included loss of superficial sensitivity, of proprioception, loss of sensitivity to pain and temperature below the injury, and ipsilateral hemiplegia.
Brown Sequard syndrome is a type of neurological pathology characterized by a hemisection of the spinal cord. The most common is that it occurs as a result of trauma or tumor growth at the spinal level. These events cause a sensory and proprioceptive alteration and various abnormalities related to muscle weakness and paralysis..
The human nervous system is classically divided into two fundamental sections, the central nervous system and the peripheral nervous system..
The central nervous system is made up of various nerve structures, including the brain, cerebellum, and spinal cord. For its part, the peripheral nervous system is made up of ganglia and the set of cranial and spinal nerve terminals..
The spinal cord is a fundamental part of our nervous system. Visually, it is the structure that is contained within the vertebrae and is distinguished as a long whitish cord.
The essential function of this structure is based on the reception and transmission of sensory and motor information between the different body regions and the brain centers, through all the nerve terminals that arise from it..
In relation to the different parts of the spinal column where it is contained and the type of spinal nerves that leave it, we can identify different sections: cervical, thoracic, lumbar, sacral and coccygeal. When an injury occurs in any of these divisions, the transmission of information from the affected region and all the sections below it will be lost..
In the case of Brown Sequard syndrome, its clinical features are due to a partial section of the spinal cord. A spinal hemisection is usually defined in most cases by the loss of motor and sensory function in different areas of the body..
Brown Sequard syndrome is a rare neurological disorder in the general population. Epidemiological studies place its incidence at 2% of all traumatic injuries located in the spinal cord.
The annual incidence of Brown Sequard syndrome does not exceed 30 to 40 cases per million people worldwide. In the United States, there is no national registry of the number of traumatic and non-traumatic spinal injuries seen in emergency medical services, so the true incidence of Brown Sequard syndrome is not precisely known.
It is estimated that about 12,000 new cases of traumatic injuries are identified per year, so this syndrome can represent between 2 and 4% of the total. It is thought that it may affect about 273,000 throughout the United States..
Demographic analyzes indicate that it is more prevalent in women than in men. In addition, it is usually associated with the age group between 16 and 30 years old..
However, the average age of people with Brown Sequard syndrome is usually in the 40s..
The signs and symptoms secondary to spinal cord injuries or hemilesions will vary depending on the height of the spinal cord and therefore the areas that are affected. At a general level, all of them tend to generate to a greater or lesser extent some of the following alterations:
Loss or decrease of sensation (hypoesthesia-anesthesia) usually mainly affects surface sensations, pain and temperature.
The classic presentation of this medical condition is related to the contralateral loss (opposite side to the spinal cord injury) of sensitivity to pain (hypoalgesia) and temperature in body regions lower than those innervated by the affected spinal cord region..
Likewise, a loss of sensitivity to vibratory stimuli can be identified at the ipsilateral level (same side of the spinal cord injury).
Proprioception refers to the ability of our body to be permanently informed of the position of all its members. This sense allows us to regulate the direction of our actions, the amplitude of the movements or the emission of automatic reactions..
In cases of Brown Sequard syndrome, a dysfunction of the proprioceptive system can be identified.
Brown Sequard syndrome usually results in a significant loss of motor function at the ipsilateral level..
In many cases, hemiparesis (reduced motor capacity) or hemiplegia (complete paralysis) of one of the body halves can be identified..
Muscle paralysis is usually accompanied by other types of complications:
Brow Sequard syndrome usually begins in most cases with some initial symptoms:
Subsequently, the clinical picture evolves towards the development of sensory abnormalities and muscle paralysis.
Spinal cord injuries can be the result of multiple pathological factors or medical conditions. Often, Brown Sequard syndrome is the result of some type of traumatic injury that affects areas located in the territory of the spine or neck..
The most common cause is usually associated with penetrating mechanisms, such as gunshot or stab wounds, fractures, dislocations, or falls. Some hospital causes such as surgical accidents or injuries due to removal of a cerebrospinal fluid drainage catheter can also be identified..
Traumatic injuries may in turn involve blunt contusions or mechanical compression damage..
Finally, among the non-traumatic etiological factors we can find: primary or metastatic tumor processes, multiple sclerosis, herniated disc, transverse myelitis, radiation, epidural hematoma, chiropractic manipulation, hemorrhages, ischemia, syphilis, herpes simplex infection, meningitis, ossifications , tuberculosis, drug use, etc..
The suspected diagnosis of Brown Sequard syndrome is based on clinical findings. It is essential to identify sensory abnormalities and various alterations related to muscle weakness and paralysis..
It is essential to analyze the individual and family medical history and the reason for admission to emergency medical services. Subsequently, to confirm the presence of spinal cord injuries it is essential to perform various imaging tests.
Magnetic resonance imaging is often the classic technique for evaluating patients with suspected Brown Sequard syndrome. This technique allows localization of the spinal cord injury.
In addition to this, one of the central points of diagnosis is the identification of the etiological cause, be it a traumatic, vascular, neurological, infectious event, etc..
Early and accurate diagnosis allows the control of secondary medical complications and the development of permanent functional sequelae.
There is no specifically designed treatment or therapeutic approach for Brow Sequard syndrome. The intervention and the medical professionals involved vary significantly in each case.
Generally, the therapeutic approach is based on immobilization of the patient to prevent spinal cord damage and surgical repair. Symptom control usually requires the administration of different drugs such as analgesics and corticosteroids..
Likewise, for the treatment of paralysis and weakness it is essential that physical therapy begin immediately, to maintain muscle tone and strength. The use of mobility devices, such as wheelchairs or other orthopedic devices, may be necessary.
Occupational rehabilitation programs aimed at restoring the functional independence of the affected person are also often used..
Once the etiological cause of this syndrome has been treated, the prognosis and recovery are usually good. More than half of those affected recover motor capacity during the first year, achieving the first advances one or two months after the injury.
Between 3 and 6 months later, recovery tends to progress slowly, lasting up to two years. The usual course of recovery follows the following pattern:
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