Brown-Sequard Syndrome

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1- Introduction

2- Anatomical Overview

3- Causes

4- Treatment 


Brown-Sequard syndrome is a rare neurological condition caused by an injury to one side of the spinal cord. It’s named after the physiologist who first described it, Charles-Édouard Brown-Sequard. This syndrome is often the result of trauma, such as a stab wound or a spinal cord injury, but it can also be caused by tumors, infections, or other conditions affecting the spinal cord.

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Anatomical Overview

Brown-Sequard syndrome results from damage to one side of the spinal cord, leading to a characteristic pattern of neurological deficits. The spinal cord is divided into two halves: the right and left sides. Each half controls sensation and motor function for the corresponding side of the body. In this syndrome, the injury typically affects one half of the spinal cord, disrupting nerve signals.

On the side of the injury, there is a loss of voluntary motor function and position sense (proprioception), as well as a decrease in sensitivity to vibration and touch. This occurs because the injury disrupts the ascending pathways responsible for carrying sensory information to the brain on the affected side. However, pain and temperature sensation are preserved on the side of the injury due to the crossing of these pathways to the opposite side of the spinal cord before ascending to the brain.

On the opposite side of the injury, there is a loss of pain and temperature sensation. This is because the pathways carrying these sensations ascend on the same side of the spinal cord for a short distance before crossing to the opposite side. Therefore, an injury on one side of the spinal cord affects the pathways carrying pain and temperature sensation from the opposite side of the body.

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  • Trauma: The leading cause of Brown-Séquard syndrome is trauma, such as a penetrating injury (e.g., stab or gunshot wound) or a blunt injury (e.g., from a car accident or fall), which damages one side of the spinal cord while leaving the other side intact.

  • Tumors: Tumors, both primary spinal cord tumors and metastatic tumors from other parts of the body, can compress or invade the spinal cord, leading to Brown-Séquard syndrome.

  • Spinal Cord Lesions: Lesions within the spinal cord, such as abscesses or hematomas, can cause damage to one side of the spinal cord and result in Brown-Séquard syndrome.

  • Spinal Cord Infarction: A blockage of the blood supply to one side of the spinal cord (spinal cord infarction) can cause ischemic damage and lead to Brown-Séquard syndrome.

  • Infections: Infections of the spinal cord, such as tuberculosis or fungal infections, can cause damage to one side of the spinal cord and result in this syndrome.

  • Degenerative Conditions: Rarely, degenerative conditions affecting the spinal cord, such as multiple sclerosis or spinal cord arteriovenous malformations, can lead to Brown-Séquard syndrome.

  • Surgical Complications: Complications from spinal surgeries, such as damage to one side of the spinal cord during the procedure, can result in this syndrome.


  • Acute Care:

    • Immobilization: Stabilizing the spine to prevent further damage.
    • Monitoring: Close monitoring of vital signs and neurological status.
  • Medical Management:

    • Pain Management: Medications to alleviate pain, which can be significant in some cases.
    • Steroids: Anti-inflammatory medications like corticosteroids may be used to reduce swelling and inflammation around the spinal cord.
  • Surgery:

    • Decompression Surgery: If the syndrome is caused by a compressive lesion like a tumor or a herniated disc, surgery may be needed to relieve pressure on the spinal cord.
    • Stabilization Surgery: In cases of spinal cord injury with instability, surgery may be required to stabilize the spine.
  • Rehabilitation:

    • Physical Therapy: To improve strength, mobility, and coordination.
    • Occupational Therapy: To learn adaptive techniques for daily activities.
    • Speech Therapy: If there are speech or swallowing difficulties.
    • Assistive Devices: Such as braces, walkers, or wheelchairs, to improve mobility and independence.
  • Pain Management:

    • Medications: Anticonvulsants or antidepressants may be used to manage neuropathic pain.
    • Interventional Procedures: Such as nerve blocks or spinal cord stimulation, may be considered for severe pain.
  • Management of Complications:

    • Bladder and Bowel Management: Techniques and medications to manage bladder and bowel dysfunction.
    • Skin Care: To prevent pressure sores, as individuals with reduced sensation are at higher risk.
  • Psychotherapy and Counseling:

    • To help cope with the emotional and psychological impact of the condition.
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