Brown-Séquard syndrome is a rare condition that usually occurs as a result of spinal cord injury. The patient cannot perceive pain or temperatures on one side of the body. Only rarely is it the so-called pure Brown-Séquard syndrome; in many cases, an incompletely expressed form of the syndrome is present.
What is Brown-Séquard syndrome?
Brown-Séquard syndrome is the term used to describe a so-called symptom complex that occurs in the context of hemiplegic spinal cord damage. Muscle paralysis as well as dissociated disturbances of sensibility occur. Brown-Séquard syndrome was first documented between 1850 and 1851 by Charles-Édouard Brown-Séquard; Brown-Séquard syndrome occurs primarily after injury or crushing of the spinal cord. Sometimes, a tumor in the spinal canal may also be responsible for the development of Brown-Séquard syndrome. The spinal cord consists of ascending sensory and descending motor nerve tracts that can also cross to the other side of the medulla. If damage occurs, a diffuse clinical picture develops – not as in total paraplegia: while paralysis symptoms occur on one side, the patient experiences disturbances in pain, pressure, and temperature perception on the other side.
Causes
Brown-Séquard syndrome occurs extremely rarely. The reasons why Brown-Séquard syndrome may occur are varied: predominantly, Brown-Séquard syndrome results from blunt or penetrating injury, sub- or epidural hematoma of the spinal meninges, or herniation of the intervertebral discs. Local pimary tumors or metastases may also be responsible for the development of Brown-Séquard syndrome. The cause is of essential importance with regard to further treatment. For this reason, the physician must recognize in advance which reasons were responsible that Brown-Séquard syndrome could occur in the first place. A spontaneous occurrence is de facto not possible. Occasionally, acute symptoms may occur, but these are mainly indicative of a tumor. As a rule, however, the syndrome occurs only in association with preexisting injuries to the spinal cord.
Symptoms, complaints, and signs
Brown-Séquard syndrome manifests itself predominantly by neurological functional deficits. Doctors distinguish between motor and sensory deficits. Motor deficits include, for example, ipsilateral spastic leg paralysis, which occurs because of damage to the pyramidal tract (tractus corticospinalis). Sensory functional deficits include so-called epicritic sensitivity of the ispilateral side when damage has occurred in the posterior cord pathway. There is also a failure of pain and temperature perception, and here physicians speak of a dissociated sensory disturbance. The vegetative symptoms include redness as well as overheating of the skin; in some cases, an absence of sweat secretion has also been documented. Thus, the patient initially notes a unilateral paralysis, but notices that he or she cannot perceive temperature or pain on the other side of the body. Such symptoms, in conjunction with the existing and known medical history, must therefore by no means be ignored or postponed. If there is a possibility that it is Brown-Séquard syndrome, a medical professional must therefore be contacted immediately.
Diagnosis and course
Pure Brown-Séquard syndrome represents a rarity. In almost all cases, medical professionals document an incomplete form of the syndrome; sometimes – due to other injuries – other symptoms and complaints may occur that are by no means typical of Brown-Séquard syndrome. The physician must therefore carry out neurological examinations, whereby appropriate tests of the motor function come to the fore here. Furthermore, the physician checks the depth as well as surface sensitivity, the patient’s sense of temperature and tries to determine the localization of the lesion level based on the sensory deficits. To confirm the diagnosis, imaging techniques are used as support. These are mainly X-rays, magnetic resonance imaging, and computed tomography scans. Within the framework of imaging procedures, it is possible that the cause of the lesion and its extent can be identified.Such diagnoses are made primarily by medical specialists; therefore, it is advisable to consult a physician who specializes in spinal cord injuries.
When should you see a doctor?
In general, Brown-Séquard syndrome does not require an additional visit to a physician for diagnosis. In most cases, the diagnosis is already made in the hospital because the affected person can no longer feel or even move parts of the body. However, a doctor should be consulted if paralysis or disturbances in sensitivity occur suddenly or without any particular injury. Sudden redness on the skin or the lack of perception of temperature differences can also indicate Brown-Séquard syndrome and should definitely be treated by a doctor. Especially after accidents, blows or falls a doctor must be consulted. In this context, insensitivity to pain is also a crucial signal that may indicate this disease. The diagnosis of Brown-Séquard syndrome is made by a general practitioner or during an MRI. This also allows a good diagnosis of the causes of the sensory disturbances. The further treatment depends strongly on the respective cause. If it is a tumor, it can be removed. In the case of irreversible injuries, no more therapy can be performed.
Treatment and therapy
If the physician determines that a tumor is pressing on the patient’s spinal cord, surgery may result in removal of the tumor and thus alleviate Brown-Séquard syndrome. If acute symptoms develop that suggest the condition is what is known as mechanical spinal cord compression, the affected person undergoes immediate surgery. Although surgery does not always improve the neurological situation, it does facilitate the subsequent course of treatment. Follow-up care and remobilization also lead to better results if the medical professional operates on the patient. After surgery, it is important for the patient to take advantage of physiotherapeutic measures. A cure is not possible. In the end, the surgical treatments and rehabilitation measures serve to improve the symptoms. The goal is for the patient – after surgical intervention and rehabilitation – to be able to move around independently with assistive devices.
Outlook and prognosis
In many cases, Brown-Séquard syndrome cannot be treated. This is especially the case when the syndrome occurs as a result of an injury to the spinal cord. In this case, the injury cannot be corrected, so patients suffer from limitations throughout their lives. In the case of a tumor, it can be removed. However, the further course of this depends very much on where exactly the tumor is located and whether metastasis has already occurred. In the case of metastasis, the patient’s life expectancy is significantly reduced, resulting in premature death. Even after successful removal of the tumor, the patient is often dependent on various physiotherapy measures to restore movement. This allows the affected person to move around independently. If no treatment is given for Brown-Séquard syndrome, the affected person’s condition will remain the same or worsen if the tumor is the trigger of the disease. No self-healing will occur. If Brown-Séquard syndrome occurs as a result of an accident, most affected individuals also suffer from other injuries or diseases.
Prevention
Because Brown-Séquard syndrome develops because of injuries or tumors, prevention is not possible. It is advisable, if symptoms suggestive of Brown-Séquard syndrome occur, to contact a medical professional immediately. Earlier treatment may subsequently lead to faster rehabilitation of the affected person.
Follow-up
The options for follow-up care are usually severely limited in Brown-Séquard syndrome. The syndrome itself can only be treated symptomatically and not causally, as it is a genetic condition. The affected person is always dependent on a surgical intervention to relieve the discomfort in the back. After the operation, the patient needs rest and recovery. Unnecessary stress should be avoided.If the reason for Brown-Séquard syndrome is a tumor, further and especially regular examinations by a doctor for other tumors can be very useful. Likewise, after the surgical intervention, physiotherapy measures are necessary to restore the complete movement of the affected person. Many of the exercises from physiotherapy can also be performed at home and with the help and support of friends or family, so that healing is accelerated. However, the affected person cannot always move around on his own and is usually still dependent on other aids in everyday life. However, the life expectancy of the affected person is not negatively affected by Brown-Séquard syndrome. In some cases, psychological treatment may also be necessary or useful for this syndrome if depression or other psychological upsets occur.
Here’s what you can do yourself
The motor limitations of Brown-Séquard syndrome can only be reduced by surgery. Since a cure is not possible, therapy is symptomatic. In this regard, each affected person can become active himself. After the operation, which is usually performed, patients should constantly participate in the prescribed physiotherapy. Only if patients repeat the exercises at home do they have a good chance of satisfactory remobilization. Furthermore, all postoperative measures such as physical rest, avoidance of stress, regular exposure to fresh air, a diet rich in vital substances and a healthy lifestyle are considered to be very beneficial for the healing process. Since paralysis symptoms and the prospect of a life in a wheelchair are psychologically very stressful for those affected, accompanying psychotherapy is also advisable. In addition, self-help groups – contacts can be established via the Internet or the attending physician – can provide a platform for the exchange of experiences. Even if the operation often restores mobility to those affected, neurological disorders remain. Due to the lack of sensitivity to pain and temperature, caution is required in everyday life. Affected persons should pay attention to sufficient heat and skin protection by adequate clothing, so that hypothermia or overheating do not occur. If there is an existing lack of perspiration, care should be taken to ensure adequate cooling. Possible sources of injury in the home should also be checked. Patients need to learn a new body awareness and train their perception of their physical needs. A combination of physical and psychotherapy may also assist in this regard.
