Brown-Squard Syndrome
Brown-Squard Syndrome Causes
Brown-S?quard syndrome may be the result of a spinal cord tumor, ischemia (obstruction of a blood vessel), trauma (such as a gunshot wound or puncture wound to the neck or back), or infectious or inflammatory diseases such as tuberculosis, or multiple sclerosis. It is also caused by spinal cord tumor (metastatic or intrinsic), trauma (penetrating or blunt and may include needle injection of illicit substances), degenerative disease such as disk herniation and cervical spondylosis, ischemia, and infectious/inflammatory causes, such as meningitis and herpes simplex.
Brown-Squard Syndrome Definition
Brown-S?quard syndrome, also known as Brown-S?quard's hemiplegia and Brown-S?quard's paralysis, is a loss of motricity (paralysis and ataxia) and sensation as a result of the lateral hemisection of the spinal cord. Other names for the syndrome are crossed hemiplegia, hemiparaplegic syndrome, hemiplegia et hemiparaplegia spinalis and spinal hemiparaplegia. It is an incomplete spinal cord lesion characterized by a clinical picture reflecting hemisection of the spinal cord, often in the cervical cord region. It was initially described in the 1840s after Dr. Charles Edouard Brown-Sequard sectioned one half of the spinal cord. It is a rare syndrome, made up of ipsilateral hemiplegia with contralateral pain and temperature sensation deficits because of the crossing of the fibers of the spinothalamic tract.
Brown-Squard Syndrome Effects
The hemisection of the cord leads to a lesion of each of the three main neural systems, which are the principal upper motor neuron pathway of the corticospinal tract, one or both dorsal columns, and the spinothalamic tract. Because of the injury to these three main brain pathways the patient will present with three lesions. The corticospinal lesion gives out spastic paralysis on the same side of the body (the loss of moderation by the UMN). The lesion to fasciculus gracilis or fasciculus cuneus leads to ipsilateral loss of vibration and proprioception (position sense). The loss of the spinothalamic tract results to pain and temperature sensation being lost from the contralateral side beginning one or two segments below the lesion. At the lesion site all sensory modalities are discarded on the same side, and also an ipsilateral flaccid paralysis.
Brown-Squard Syndrome Historical Background
Brown-S?quard syndrome may be the cause of penetrating injury to the spine, but many other etiologies have been described. Complete hemisection, causing classic clinical features of pure Brown-S?quard syndrome, is uncommon. Incomplete hemisection causing Brown-S?quard syndrome plus other signs and symptoms is more frequently found. These symptoms may be made up of findings from posterior column involvement such as loss of vibratory sensation.