II. Epidemiology

  1. Uncommon Spinal Injury, accounting for only 4% of spinal cord injuries per year in the U.S.

III. Pathophysiology

  1. Hemisection of the spinal cord most affects the posterior cord
  2. Unilateral (hemi-cord) cord injury affecting the dorsal columns, Corticospinal tract and Spinothalamic Tract
  3. Spinothalamic Tract crosses to the contralateral side (giving the crossed effects)
  4. Images
    1. CordSyndrome.jpg

IV. Causes

  1. Penetrating Trauma (most common)
  2. Vertebral Fracture with lateral cord compression
  3. Blunt Spinal Cord Injury
  4. Disc Herniation
  5. Epidural Hematoma
  6. Decompression Sickness complication

V. Signs

  1. Ipsilateral motor weakness
  2. Ipsilateral proprioception and vibratory Sensation loss below the lesion
  3. Contralateral pain and TemperatureSensation loss starting two levels below the lesion

VI. Associated Conditions

VII. Management

  1. Consult neurosurgery for possible decompression surgery
  2. Avoid Corticosteroids (not recommended)

VIII. Prognosis

  1. Brown-Sequard Syndrome has an overall good prognosis
  2. Motor function is recovered in more than half of cases

IX. References

  1. Decker in Chorley and Bachur (2014) Overview of Cervical Spinal Cord Injuries..., UpToDate, Wolters-Kluwer
  2. Rodriguez, Winger, Poulo and Glunk (2023) Crit Dec Emerg Med 37(3): 23-9
  3. Wagner (1997) Emerg Med Clin North Am 15:699-711 [PubMed]

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