Brown-Séquard syndrome
Cervical
intradural meningioma presenting as Brown-Séquard syndrome. Axial T1 after gadolinium injection. The mass is homogeneously enhancing and completely intradural, without extension to the foramen.
a schematic
diagram showing anatomical signification of uncomplete cord injuries
Cervical
intradural meningioma presenting as Brown-Séquard syndrome. Axial T1 at the level of C2, showing an intradural extramedullary mass occupying most of the canal and displacing the spinal cord posteriorly and to the right.
Cervical
intradural meningioma presenting as Brown-Séquard syndrome. Midline sagittal T1, showing an intradural extramedullary anterior mass occupying most of the canal and displacing the spinal cord posteriorly.
Cervical
intradural meningioma presenting as Brown-Séquard syndrome. Midline sagittal T2WI. Anterior intradural extramedullary lesion. Notice a line of CSF separating the lesion from the cord, displaced posteriorly.
Cervical
intradural meningioma presenting as Brown-Séquard syndrome. Axial T2WI at the level of C2, showing the intradural extramedullary mass anteriorly, displacing the cord posteriorly and to the right. It has a slight hyperintense signal intensity when compared to the cord parenchyma.
Cervical
intradural meningioma presenting as Brown-Séquard syndrome. Midsagittal T1WI. Homogeneous enhancement after iv gadolinium administration. Notice the dural tail in the anterior aspect of the dura, adjacent to the mass. There is no cord enhancement.
Cervical
intradural meningioma presenting as Brown-Séquard syndrome. Coronal T1WI. Homogeneous enhancement after iv gadolinium administration. The mass has well defined margins and does not invade the bone.
Long-term
course of anterior spinal cord herniation presenting with an upper motor neuron syndrome: case report illustrating diagnostic and therapeutic implications. Schematic depiction of progressive anterior spinal cord herniation. a Schematic drawing of the central position of the thoracic spinal cord within the dura. The ventral dural defect may have been caused by congenital, traumatic and/ or degenerative changes. b The 8 years follow-up MRI showed ventral displacement of the spinal cord (red) as an early sign of aSCH without sensory symptoms. c When sensory symptoms evolved and surgery was performed, a substantial part of the anterior hemicord was herniated through the dural defect. 1 Vestibulospinal tract, 2 Olivospinal tract, 3 Rubrospinal tract, 4 Lateral corticospinal tract, 5 Tectospinal tract, 6 Anterior corticospinal tract, 7 Anterior reticulospinal tract, 8 Anterior spinothalamic tract, 9 Anterior spinocerebellar tract, 10 Lateral spinothalamic tract, 11 Posterior spinocerebellar tract, 12 Fasciulus gracilis
Vertebral
artery dissection presenting as a Brown-Séquard syndrome: a case report. Sagittal T2 restore magnetic resonance image demonstrating a posterior hyperintense lesion (red arrow) at the cranio-cervical junction involving the caudal medulla and the upper cervical cord.
Spinal cord
infarction presenting as Brown-Séquard syndrome from spontaneous vertebral artery dissection: a case report and literature review. a Sagittal T2-weighted magnetic resonance image of cervical spine reveals spinal cord enlargement with hyperintense lesion at the level of C1–3 (red arrow). b Axial T2WI shows hyperintense signal of right spinal cord (red arrow). This is consistent with spinal cord infarction (SCI). (c)(d) HR-MRI VISTA sequence shows narrowing of the right vertebral artery at the level of C1–3 with eccentric high signal parallel to the narrowed lumen (red arrow)
Spinal cord
infarction presenting as Brown-Séquard syndrome from spontaneous vertebral artery dissection: a case report and literature review. Post-treatment image (a) After 3 months of therapy, Sagittal T2-weighted magnetic resonance image of cervical spine shows the range of abnormal signal of spinal cord in level C1–3 diminished. (b)(c) HR-MRI VISTA reexamination shows that lumen recanalization of the right vertebral artery
Spinal cord
infarction presenting as Brown-Séquard syndrome from spontaneous vertebral artery dissection: a case report and literature review. Spinal cord arerial supply. The arteries supplying the spinal cord include the anterior spinal artery (ASA), the posterior spinal artery (PSA), and the radicular artery. The upper region (C1-T2 segments) of the spinal cord is supplied mainly by the vertebral artery. Starting at the level of C3, the anterior and posterior spinal arteries receive a branch from the vertebral artery, that of the radicular artery. In our case, the basic lesion of this patient is the occlusion of the cervical radicular artery caused by vertebral artery dissection, which eventually resulted in right spinal cord infarction
Brown-Séquard
syndrome • Ventral cord herniation - Ganzer Fall bei Radiopaedia
Central cord
syndrome • Incomplete spinal cord syndromes (illustrations) - Ganzer Fall bei Radiopaedia
Central cord
syndrome • Incomplete spinal cord syndromes (illustrations) - Ganzer Fall bei Radiopaedia
Brown-Séquard syndrome, also known as hemicord syndrome, is the result of damage to, or impairment of, the left or right side of the spinal cord. It is characterized by a characteristic pattern of motor and sensory deficits that are determined by the decussation pattern of various white matter tracts.
Clinical presentation
Due to some fibers crossing within the cord whilst others cross in the brainstem, the neurology is bilateral, namely :
- ipsilateral loss of proprioception, touch, and vibration sense below the lesion due to damage to the ascending dorsal columns
- ipsilateral upper motor neuron spastic paralysis below the lesion due to damage to the descending lateral corticospinal tracts
- contralateral loss of pain and temperature sensation 2 to 3 levels below the level of the lesion due to damage to the ascending lateral spinothalamic tract which cross 2 to 3 levels above the level of their respective dorsal root
- ipsilateral loss of motor and sensory function just at the level of the injured segments due to direct damage to ventral and dorsal grey matter
Pathology
There are many reported causes of damage to one side of the cord, including :
- trauma/compression
- penetrating injury (e.g. stabbing or gunshot wounds) - most common
- excessive motion (e.g. chiropractic manipulation , motor vehicle accidents)
- iatrogenic (e.g. surgery)
- compression (e.g. disc herniation, extramedullary collection)
- distortion (e.g. ventral cord herniation)
- spinal cord tumors
- vascular
- endoluminal aortic repair
- vertebral artery dissection
- spinal cord hemorrhage secondary to vascular lesions
- radiation therapy
Radiographic features
MRI
MRI is the modality of choice for assessing patients with suspected Brown-Séquard syndrome and the features in any one case will naturally depend on the underlying cause, although all will have in common (predominantly) unilateral pathology.
History and etymology
The syndrome was first described by the physiologist Charles-Édouard Brown-Séquard, who studied spinal cord trauma in sugarcane farmers in Mauritius.
See also
- Brown syndrome (orbit)
- Paterson-Brown syndrome
Siehe auch:
- Rückenmarksinfarkt
- Arteria-spinalis-anterior-Syndrom
- central cord syndrome
- Rückenmarksverletzung
- anterior cord syndrome
- Herniation Rückenmark
und weiter:
Assoziationen und Differentialdiagnosen zu Brown-Séquard-Syndrom:
