Elsevier

The Journal of Emergency Medicine

Volume 16, Issue 6, November–December 1998, Pages 847-850
The Journal of Emergency Medicine

Clinical Communications
Brown–sequard syndrome due to isolated blunt trauma1

https://doi.org/10.1016/S0736-4679(98)00096-1Get rights and content

Abstract

Blunt trauma without associated fracture or ligamentous injury is a rare cause of Brown–Sequard syndrome. We report a case of Brown–Sequard syndrome after a direct blow to the cervical spine that did not cause injury to adjacent bone or ligaments. Characteristic neurologic findings, including a unilateral hemiparesis with associated contralateral sensory findings, were noted at the time of presentation. High-dose steroids were instituted after recognition of the patient’s injury, and magnetic resonance imaging of the cervical spine revealed a unilateral cord contusion with no associated fractures. After 1 month, the patient had recovered much of his function and was able to ambulate unassisted.

Introduction

First described in 1849 by Charles Edouard Brown–Sequard 1, 2, the syndrome that bears his name refers to a characteristic spinal lesion that usually results from partial hemisection of the spinal cord. Typically occurring in males aged 15–50, the anatomic lesion results in ipsilateral motor and proprioception loss and contralateral loss of pain and temperature sensation. The etiology of this lesion varies from tumor to direct spinal cord trauma. Classically, the syndrome is associated with penetrating injury to the back or blunt injuries involving fractured vertebrae. We present a case of Brown–Sequard syndrome, following multiple blows from a lead pipe, which did not include any spinal column fractures or instability.

Section snippets

Case report

An 18-year-old male presented to our facility, a Level I trauma center, after transfer from a small community emergency department (ED) with a diagnosis of possible spinal cord injury. The patient had received multiple blows with a lead pipe over the neck and back. He had then fallen, striking the right side of his head. Immediately after the assault, he stated that he was unable to move because he felt “numb.” The patient was evaluated at the community ED where plain radiographs of the

Discussion

Brown–Sequard syndrome is a unique set of neurologic findings associated with hemisection of the spinal cord. Classically, there is a contralateral loss of pain and temperature sensation, and an ipsilateral loss of position and vibration sensation, as well as ipsilateral paralysis and hyperaesthesias (3). Light touch usually is not affected. Distribution of Brown–Sequard syndrome is 75% thoracic, 17% cervical, and 8% lumbar (2).

The motor paralysis seen in this syndrome stems from disruption of

References (16)

  • R.D. Herr et al.

    An unusual presentation of Brown–Sequard syndrome

    Ann Emerg Med

    (1987)
  • W.H. Merry et al.

    Functional outcome after incomplete spinal cord injuries due to blunt injury

    Injury

    (1996)
  • M.J. Aminoff

    Historical perspective: Brown–Sequard and his work on the spinal cord

    Spine

    (1996)
  • D.W. Oller et al.

    Blunt cervical spine Brown–Sequard injurya report of three cases

    Am Surg

    (1991)
  • M. Boukobza et al.

    Spinal epidural haematomareport of 11 cases and review of the literature

    Neuroradiology

    (1994)
  • E.S. Connolly et al.

    Management of spinal epidural hematoma after tissue plasminogen activator

    Spine

    (1996)
  • T. Kimbro et al.

    A case of spinal cord decompression sickness presenting as partial Brown–Sequard syndrome

    Neurology

    (1997)
  • O.R. Hubschmann et al.

    Syndrome of intramedullary gunshot wound with incomplete neurologic deficitcase report

    J Trauma

    (1988)
There are more references available in the full text version of this article.

Cited by (10)

View all citing articles on Scopus
1

Clinical Communications (Adults) is coordinated by Ron M. Walls, md, of Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts

View full text