Brown-Séquard syndrome is the result of a hemicord lesion (i.e. damage or impairment to the left or right side of the spinal cord).
Due to some fibres crossing within the cord whilst others cross in the brainstem, the neurology is bilateral, namely 1:
- ascending lateral spinothalamic tract (which cross 1-2 levels above the level of their respective dorsal root) result in contralateral loss of pain and temperature sensation
There are many reported causes of damage to one side of the cord, including:
- penetrating injury (e.g. stabbing)
- excessive motion (e.g. chiropractic manipulation 1, motor vehicle accidents)
- disc herniation
- endoluminal aortic repair
- vertebral artery dissection
- ventral cord herniation
- radiation therapy 2
MRI is the modality of choice for assessing patients with suspected Brown-Séquard syndrome and the features in any once case will naturally depend on the underlying cause, although all will have in common (predominantly) unilateral pathology.
History and etymology
The syndrome was first described by the physiologist Charles-Édouard Brown-Séquard, who studied spinal cord trauma in sugarcane farmers in Mauritius.
- 1. Lipper MH, Goldstein JH, Do HM. Brown-Séquard syndrome of the cervical spinal cord after chiropractic manipulation. AJNR Am J Neuroradiol. 1998;19 (7): 1349-52. Pubmed citation
- 2. Mathews MS, Peck WW, Brant-Zawadzki M. Brown-Séquard syndrome secondary to spontaneous bleed from postradiation cavernous angiomas. AJNR Am J Neuroradiol. 2008;29 (10): 1989-90. doi:10.3174/ajnr.A1158 - Pubmed citation