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                Traumatic Brown-Sequard syndrome– clinico-radiological correlation on MRI

                
                

                S Dlangamandla, MB BCh
            

            N Mahomed, MB BCh, FCRad(D)
        

        Department of Radiology, University of the Witwatersrand, Johannesburg

        
            Corresponding author: N Mahomed (nasreen.mahomed@wits.ac.za)

            A 34-year-old man presented with a history of
            a stab wound to the left side of the neck. Physical examination
            revealed an ipsilateral left-sided hemiplegia and contralateral loss of
            sensation. A clinical diagnosis of Brown-Sequard syndrome was made.
            Magnetic resonance imaging (MRI) findings demonstrated hyperintensity
            at C4 and C5 levels on sagittal T2-weighted sequence of the cervical
            spine (Fig. 1) with limitation to the left hemicord demonstrated in the
            axial plane (Fig. 2), accounting for the Brown-Sequard syndrome. The
            patient was managed with supportive treatment.

            Discussion

            Brown-Sequard
            syndrome, first reported in 1849, is characterised by hemisection of
            the cord with disruption of the descending lateral corticospinal tracts
            resulting in ipsilateral
            hemiplegia, and damage of the ascending lateral spinothalamic tracts
            (which cross within one or two levels of the dorsal root entrance)
            resulting in contralateral
            loss of pain and temperature. Damage to the dorsal columns results in
            ipsilateral loss of proprioception and fine touch below the level of
            the lesion.1
            ,
            2
        

        The most common cause of Brown-Sequard syndrome is
        penetrating trauma to the spinal cord, but it can also occur with blunt
        trauma, disc herniation, syringomyelia and spinal tumours.1
        ,
        2 
        In our patient, the high signal on MRI in the left hemicord at the
        level of the transection correlates well with the clinical features.

        
        

        1. Sathirapanya P, Taweelarp A, Sae Heng S, Riabroi K. Brown-Sequard
        syndrome from cervical disc herniation, a case report and review of
        literature. Neurology Asia 2007;12:65-67.

        1. Sathirapanya P, Taweelarp A, Sae Heng S, Riabroi K. Brown-Sequard
        syndrome from cervical disc herniation, a case report and review of
        literature. Neurology Asia 2007;12:65-67.

        2. Pablo M, Pedro G, Rafael A, Ariel K, Ana R. Brown-Sequard syndrome
        after blunt cervical spine trauma: clinical and radiological
        correlations. Eur Spine J 2007;16:1165-1170.

        2. Pablo M, Pedro G, Rafael A, Ariel K, Ana R. Brown-Sequard syndrome
        after blunt cervical spine trauma: clinical and radiological
        correlations. Eur Spine J 2007;16:1165-1170.

    

    
        
            
                

            

            
            

        

        
            
            

            Fig. 1. Sagittal T2-weighted MRI of cervical spine demonstrates spinal cord hyperintensity at C 4 and C5 levels.
            				

        

        
            
                
            

            
                Fig. 2. Axial T2-weighted MRI at C4 and C5 levels
                demonstrates the extent of spinal cord hyperintensity limited to the
                left hemicord in keeping with the clinical features of Brown-Sequard
                syndrome.