Brown-Sequard Syndrome

Summary

Brown-Sequard syndrome is caused by a hemisection of the spinal cord. The symptoms seen can be divided into 2 main categories, depending on their location relative to the lesion.

At the same level as the lesion, patients exhibit ipsilateral loss of all sensation, as well as lower motor neuron signs.

In contrast, below the level of the lesion, patients exhibit ipsilateral upper motor neuron signs. Damage to the dorsal column results in ipsilateral loss of the vibration, proprioception, and fine-touch sensation. In addition, damage to the spinothalamic tract results in contralateral loss of pain and temperature sensation. Finally, Brown-Sequard can also be associated with Horner syndrome if the lesion occurs high up on the spine, usually above the T1 vertebrae. 

Key Points

• Brown-Sequard Syndrome
  • Pathology
    • Hemisection of the spinal cord
      • E.g. knife injury, gunshot wound, multiple sclerosis
  • Presentation
    • Ipsilateral loss of all sensation
      • at level of lesion
    • Ipsilateral LMN signs (e.g. flaccid paralysis)
      • at level of lesion
    • Ipsilateral UMN signs
      • below level of lesion
      • Due to corticospinal tract damage
    • Ipsilateral loss of proprioception, vibration, and fine touch (2 point discrimination)
      • below level of lesion
      • Due to dorsal column damage
    • Contralateral loss of pain, temperature, and crude touch (non-discriminative)
      • below level of lesion
      • Due to spinothalamic tract damage
    • Ipsilateral Horner syndrome
      • If lesion occurs above T1
      • Due to damage of oculosympathetic pathway