Brown-Sequard syndrome is a rare spinal disorder that results from an injury to one side of the spinal cord in which the spinal cord is damaged but is not severed completely. It is usually caused by an injury to the spine in the region of the neck or back. In many cases, affected individuals have received some type of puncture wound in the neck or in the back that damages the spine and causes symptoms to appear.
Characteristically, the affected person loses the sense of touch, vibrations and/or position in three dimensions below the level of the injury (hemiparalysis or asymmetric paresis). The sensory loss is particularly strong on the same side (ipsilateral) as the injury to the spine. These sensations are accompanied by a loss of the sense of pain and of temperature (hypalgesia) on the side of the body opposite (contralateral) to the side at which the injury was sustained. .
Symptoms of Brown-Sequard syndrome usually appear after an affected individual experiences a trauma to the neck or back. First symptoms are usually loss of the sensations of pain and temperature, often below the area of the trauma. There may also be loss of bladder and bowel control. Weakness and degeneration (atrophy) of muscles in the affected area may occur. Paralysis on the same side as that of the wound often occurs. Paralysis may be permanent if diagnosis is delayed.
Individuals with this syndrome have a good chance of recovering a large measure of function. More than 90% of affected individuals recover bladder and bowel control, and the ability to walk. Most affected individuals regain some strength in their legs and most will regain functional walking ability.
This syndrome is often a consequence of a traumatic injury by a knife or gunshot to the spine or neck. In many cases, however, it is caused by, or is the result of, other spinal disorders such as cervical spondylosis, arachnoid cyst or epidural hematomas. Brown-Sequard syndrome may also accompany bacterial or viral infections. Blunt traumas, such as occur in a fall or automobile accident, on rare occasions may be the cause of the Brown-Sequard syndrome.
The medical literature cites, as causing or being associated with BSS, the following conditions: lateral curvature of the spine (kyphosis), Chiari I malformation, methamphetamine injection in the neck, multiple sclerosis, spinal epidural hematoma, intramedullary spinal cord tumor, and myeloschisis. Among the infectious or inflammatory causes cited are: meningitis, empyema, herpes zoster, herpes simplex, myelitis, and tuberculosis. .
Brown-Sequard syndrome is a rare disorder that affects males and females in equal numbers. More than 500 cases have been reported to date. The incidence of Brown-Sequard syndrome has been estimated to be 2% of all traumatic spinal cord injuries. The annual incidence of all forms of spinal cord injury is estimated to be 30-40 per 1,000,000 people.
Symptoms of the following disorders can be similar to those of Brown-Sequard Syndrome. Comparisons may be useful for a differential diagnosis:
Motor Neuron Disease is a degeneration of motor neurons. Motor neurons control the behavior of muscles. Motor Neuron Disease may affect the upper motor neurons, which control the signals from the brain to the spinal cord, or the lower motor neurons which lead from the spinal cord to the muscles of the body. (For more information on this disorder, choose "Motor Neuron Disease" as your search term in the Rare Disease Database.)
Progressive Spinal Muscular Atrophy is a slowly progressive Motor Neuron Disease. Muscle weakness and wasting may begin in the hands and eventually affect the arms, shoulders, legs, and the rest of the body. Muscle twitching may occur in the limbs and tongue. (For more information on this disorder, choose "Motor Neuron Disease" as your search term in the Rare Disease Database.)
Primary Lateral Sclerosis affects adults. It is characterized by progressive degeneration of the upper motor neurons. Difficulty in speech and swallowing, semi or complete paralysis of the legs and/or arms, and muscle twitching and spasticity may occur. (For more information on this disorder, choose "Motor Neuron Disease" as your search term in the Rare Disease Database.)
Stroke is one of the most common neurological conditions affecting the central nervous system. Stroke is caused by a blockage of blood flow to part of the brain. The may happen because of a blood clot or because of the bursting of an aneurysm in the brain.
There is no specific treatment for individuals with Brown-Sequard syndrome. In most instances, treatment focuses on the underlying cause of the disorder. Treatment may involve drugs that control muscle symptoms, and there is some dispute as to whether high-dose steroid administration is effective.
Devices that help an affected individual continue daily activities such as braces, hand splits, limb supports, or a wheelchair are important. Various other aids may be necessary if the patient has difficulty breathing or swallowing. Other treatment is symptomatic and supportive.
The National Institute of Child Health and Human Development (NICHD) is sponsoring a Phase II and Phase III clinical trial designed to improve walking ability after spinal cord injury. Patients with Brown-Sequard syndrome may be eligible to participate in the study.
It is well known that incomplete spinal cord injury often makes walking very difficult. A group of physical therapists are trying to determine the effect of treadmill speed on spinal cord function and walking performance.
Recently, evidence has been building to contradict the conventional wisdom that recovery of nerve function following spinal cord injury was not possible. It has been shown that nerve circuits (neuronal circuits) may reorganize by strengthening previously inactive connections and circuits. Sensory information related to movement is used to improve treadmill and overground walking.
About 16 persons will participate in the study, which is based at the University of Florida in Gainesville.
For further information contact: Andea L. Behrman, PhD Principal Investigator University of Florida Tel: 352-273-6117 e-mail: abehrman@hp.ufl.edu or
Michelle L. Woodbury, OTR, MA e-mail: mwoodbury@hp.ufl.edu Study ID number is: K01HD01348
Information on current clinical trials is posted on the Internet at www.clinicaltrials.gov. All studies receiving U.S. government funding, and some supported by private industry, are posted on this government web site.
For information about clinical trials being conducted at the NIH Clinical Center in Bethesda, MD, contact the NIH Patient Recruitment Office:
Massicotte EM, Montanera W, Ross Fleming JF, et al. Idiopathic spinal cord herniation: report of eight cases and review of the literature. Soine. 2002;27:E233-41.
Antich PA, Sanjuan AC, Girvent FM, et al. High cervical disc herniation and Brown-Sequard syndrome. A case report and review of the literature. J Bone Joint Surg Br. 1999;81:462-63.
JOURNAL ARTICLES Abe M. Incomplete Brown-Sequard syndrome caused by cervical kyphosis secondary to neurofibromatosis: report of a case. J Orthop Sci. 2003;8:602-06.
Lim E, Wong YS, Lo YL, et al. Traumatic atypical Brown-Sequard syndrome: case report and literature review. Clin Neurol Neurosurg. 2003;105:143-45.
Pollard ME, Apple DF. Factors associated with improved neurologic outcomes in patients with incomplete tetraplegia. Spine. 2003;28:33-39.
Cellerini M, Bayon S, Scazzeri F, et al. Idiopathic spinal cord herniation: a treatable cause of Brown-Sequard syndrome. Acta Neurochir (Wien). 2002;144:321-25.
Sakakibara R, Hattori T, Uchiyama T, et al. Urinary dysfunction in Brown-Sequard syndrome. Neurourol Urodyn. 2001;20:661-67.
McCarron MO, Flynn PA, Pang KA, et al. Traumatic Brown-Sequard-plus syndrome. Arch Neurol. 2001;58:1470-72.
FROM THE INTERNET NINDS Brown-Sequard Syndrome Information Page. Reviewed 2-25-2003. 2pp. www.nih.gov/health_and_medical/disorders/brown-sequard.htm?format=printable
NINDS Spinal Cord Injury Information Page. Reviewed 7-01-2001. www.nih.gov/health_and_medical/disorders/sci.htm?format=printable
Beeson MS. Brown-Sequard Syndrome. emedicine. Last Updated: July 30, 2003. 7pp www.emedicine.com/emerg/topic70.htm
Spinal Cord Society 19051 County Hwy. 1 Fergus Falls, MN 56537 USA Tel: (218)739-5252 Fax: (218)739-5262 Email: scs-nc@nc.rr.com Internet: http://www.spinalcordsociety.com
National Spinal Cord Injury Association 6701 Democracy Suite 300-9 Bethesda, MD 20817 USA Tel: (301)214-4006 Fax: (301)881-9817 Tel: (800)962-9629 Email: info@spinalcord.org Internet: http://www.spinalcord.org
National Institute of Neurological Disorders and Stroke (NINDS) 31 Center Drive 8A07 Bethesda, MD 20892-2540 Tel: (301)496-5751 Fax: (301)402-2186 Tel: (800)352-9424 Email: braininfo@ninds.nih.gov Internet: http://www.ninds.nih.gov/
American Spinal Injury Association 345 East Superior Room 1436 Chicago, IL 60611 Tel: (312)238-6207 Fax: (312)238-0869 Email: mars@northwestern.edu
Spinal Cord Injury Network International 3911 Princeton Drive Santa Rosa, CA 95405-7013 Tel: (707)577-8796 Fax: (707)577-0605 Tel: (800)548-2673 Email: library@spinalcordinjury.org Internet: http://www.spinalcordinjury.org
Genetic and Rare Diseases (GARD) Information Center PO Box 8126 Gaithersburg, MD 20898-8126 Tel: (301)519-3194 Fax: (240)632-9164 Tel: (888)205-2311 TDD: (888)205-3223 Email: gardinfo@nih.gov Internet: http://www.genome.gov/10000409
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