Brown-Séquard syndrome and cervical post-traumatic subarachnoid hematoma

Cervical Traumatic SSH are very rare in literature. They are usually caused by cardiopulmonary diseases that increase vascular pressure causing spinal vessels rupture.In thoracolumbar spine, the spinal puncture is the most common cause. The ventrolateral position is even more unusual.In traumatic brain injury (TBI), an abrupt extension–flexion movement could have caused the rupture of subarachnoid vessels. This, accompanied by the slowed blood “wash out” (probably due to the previous osteoarthrosis and spinal canal stenosis), led to the formation of an organized clot, which caused an acute spinal cord compression syndrome.Cervical subarachnoid spinal hematoma can present as Brown-Séquard syndrome. The treatment is prompt surgical removal and decompression. The posterior approach (partial hemilaminectomy with or without laminoplasty) with microsurgical technique is feasible, fast and simple to evacuate the hematoma with good results. Surgical nuances in posterior approach are: small spinal canal, difficulty in mobilizing the cervical cord, these haematomas are wrapped and attached to the spinal cord or nerve roots by multiple arachnoid bands, requiring techniques of Microdissection for its evacuation unlike the epidural and subdural haematomas that are easily aspirated.Here, we report a unique case of a ventrolateral SSH due to TBI.     

Idiopathic spinal cord herniation causing progressive Brown-Séquard syndrome

We report a 59-year-old woman with a 2.5 year history of progressive loss of temperature sensation and dysesthesia in the right and weakness in the contralateral lower limb. Magnetic resonance imaging (MRI) and computed tomography myelography of the spinal cord demonstrated transdural herniation and deformation of the spinal cord in the upper thoracic spine. The herniated part of the spinal cord was untethered and replaced, and the anterior dural defect was closed. At a clinical follow-up 3 months later, the motor and sensory functions were almost restored. MRI at this time showed disentanglement of spinal cord adherence.     

Is spontaneous spinal epidural hematoma in elderly patients an emergency surgical case?

Spontaneous spinal epidural hematoma (SSEH) is a rare condition requiring urgent diagnosis and treatment. Patients with SSEH typically present with acute onset of severe back pain and rapidly develop signs of compression of the spinal cord. The authors present a case with spontaneous resolution of SSEH which is extremely rare. We discuss a man who presented to our clinic with mild paraparesis at the seventh day of his symptoms. He had a history of poorly controlled hypertension and hypercholestrolemia requiring an antihyperlipidemic agent and anticoagulation. His upper level of hypoesthesia was at the third thoracic segment. Cervicothoracic SSEH was diagnosed by magnetic resonance imaging. Since there was a gradual recovery of the neurological deficits beginning 12 hours after the onset of symptoms, surgery was obviated and strict bed rest, serial neurological examinations, and pain controls with opiates were instituted. The neurological deficits showed complete recovery on the 25th day of the clinical course. SSEH is rare and immediate surgical decompression is suggested. Rapid neurological deterioration followed by early and progressive neurological recovery, confirmed by radiological resolution of the lesion, may indicate nonoperative treatment.     

Spinal cord infarction presenting Brown-Séquard syndrome with impaired position sense]

A 79-year-old hypertensive man presented left hemiplegia of sudden onset. Neurological examination revealed weakness of the left extremities, with hypoalgesia on the opposite side below the level C 4. He also showed Horner syndrome, facial hypoalgesia, weakness of sternocleidmastoid and trapezius muscles on the paralyzed side. The position and vibration senses were impaired on the left extremities. The position sense was more disturbed on his upper limb, to the extent that the patient was not able to recognize where his wrist was located. The cervical MRI exhibited a high signal intensity on the left half of the cord between C 2-C 5 vertebral level on T 2 WI. Bilateral vertebral arteries were patent, though severe stenosis of internal-external carotid artery bifurcation was observed on MRA. Asymmetrical distribution of upper cervical cord arteries, severe atherosclerotic change of cervical and intracranial vessels, and spondylotic cervical canal stenosis were suggested to contribute to cause the lateralized infarction of the cord, involving not only the anterior, but also posterior part, where Burdach's fascicle were probably more affected.     

Traumatic Brown-Séquard-plus syndrome

BACKGROUND: In the 1840s Brown-Séquard described the motor and sensory effects of sectioning half of the spinal cord. Penetrating injuries can cause Brown-Séquard or, more frequently, Brown-Séquard-plus syndromes. OBJECTIVE: To report the case of a 25-year-old man who developed left-sided Brown-Séquard syndrome at the C8 level and left-sided Horner syndrome plus urinary retention and bilateral extensor responses following a stab wound in the right side of the neck. RESULTS: Magnetic resonance imaging demonstrated a low cervical lesion and somatosensory evoked potentials confirmed the clinical finding of left-side dorsal column disturbance. At follow-up, the patient's mobility and bladder function had returned to normal. CONCLUSION: This patient recovered well after a penetrating neck injury that disturbed function in more than half the lower cervical spinal cord (Brown-Séquard-plus syndrome).     

Spinal algetic-tonic seizures manifesting as paroxysmal "positive" Brown-Séquard syndrome.

We report on a patient suffering from symptomatic spinal attacks in the form of a paroxysmal "positive" (algetic-tonic) Brown-Séquard syndrome. A cervical cord lesion, presumably inflammatory-demyelinating in origin, was identified as the morphological correlate of these attacks. Their pathogenesis is discussed in the light of similar case reports from the literature. For the first time, this rare type of seizure is published with a video documentation. It may deserve consideration in the differential diagnosis of otherwise unexplained paroxysmal events that present in an "epileptic" manner.     

Brown-Séquard Syndrome Caused by a Cervical Synovial Cyst

Synovial cysts are recognized as an uncommon cause of radicular and myelopathic symptoms. They are most frequently found in the lumbar region. The cervical spine or cervicothoracic junction is a rare location for a degenerative intraspinal synovial cyst as compared with the lumbar spine. At given cervical spinal levels, synovial cysts probably share clinical features with disc herniation and stenosis. However, the pathogenesis of synovial cysts remains still controversial. Here, we report a rare case of a synovial cyst in the lower cervical spine presented as Brown-Séquard syndrome and include a brief review of the literature. To the best of our knowledge, no previous report has been issued in the English literature on a synovial cyst presenting with Brown-Séquard syndrome. Neurologic function recovered completely after complete removal of the cyst and expansive laminoplasty.     

Letters from Dom Pedro II to professor Brown-Séquard: imperial correspondence and neurophysiology

The authors have analyzed the content of a selection of letters written by Dom Pedro II, the Emperor of Brazil, and sent to Doctor Charles Brown-Séquard, the famous neurologist, between 1876 and 1885. The content of those letters focuses mainly on his wife's, Princess Thereza Cristina, health issues and Dom Pedro's personal desire to foster the research into the physiological study of the nervous system.     

Battle of the titans: Charcot and Brown-Séquard on cerebral localization

OBJECTIVE: To examine the differing views of Jean-Martin Charcot and Charles Edouard Brown-Séquard-two celebrated neuroscientists of the nineteenth century-on cerebral localization as exemplified in their controversial debate of 1875 at the Société de Biologie in Paris. BACKGROUND: As clinicopathologic correlations were developed in the mid and late nineteenth century, cerebral localization was a primary topic of debate at scientific, social, and religious levels. Charcot, representing an anatomic approach to research, and Brown-Séquard, representing a physiologic perspective, disagreed fundamentally on the importance of cerebral localization to normal behavior and neurologic illness. METHODS: The minutes of the Société de Biologie meetings of 1875 and 1876, as well as primary archive documents from the Archives Nationales de l'Académie des Sciences and the Bibliothèque Charcot, were examined. RESULTS: Charcot was a strong proponent of localization theory and relied on human pathologic material primarily from isolated cerebral hematomas to establish the role of the cortex and subcortical white matter fiber tracts to motor and sensory function. Brown-Séquard used his animal physiology experiments to argue that the brain was composed of complex networks and that isolated lesions had no direct bearing on the localization of cerebral function. CONCLUSION: Although Charcot's simple and direct anatomic methods won the debate on this occasion, Brown-Séquard's prioritization of physiology and experimentalism became beacons of modern neurologic study at the close of the nineteenth century. Charcot's later failures in the study of hysteria can be viewed as attempts to mimic physiologic experiments in the manner of Brown-Séquard's scientific methods.     

Clinical course of spontaneous spinal epidural haematoma mimicking Guillain-Barré syndrome in a child: a case report and literature review

We describe a 9-year-old female with thoracic epidural haematoma. The clinical course simulated Guillain-Barré syndrome (GBS) so intravenous immunoglobulin therapy was started at the paediatric clinic. Magnetic resonance imaging (MRI) 3 days after admission showed thoracic epidural haematoma between T2 and T8. An emergency laminectomy was performed and the patient's neurological symptoms began to improve immediately after surgery and she made a full recovery during the 2 weeks of follow-up. Time is a very important factor in achieving reversibility of symptoms of compressive cord lesions, such as spinal epidural haematoma, and MRI is mandatory for patients with progressive paraplegia, even though the signs and symptoms might suggest GBS.     

Can spontaneous spinal epidural haematoma be managed safely without operation? a report of four cases

The presentation, investigation, and management of four patients with spontaneous spinal epidural haematoma is presented. In each case the diagnosis was made by MRI. At the time of diagnosis spontaneous recovery had started in each patient and therefore they were all treated conservatively. In each case follow up MRI confirmed rapid reduction in the size of the haematoma and no underlying cause was demonstrated. The presentation, diagnosis, and rationale for treatment are discussed. Conservative treatment is safe in some cases of spinal epidural haematoma if early neurological recovery has started.