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Conservative Management of Traumatic Brown-Séquard Syndrome: A Case Report

Unusual clinical course, Challenging differential diagnosis, Management of emergency care

Abdulaziz A. Alrabiah, Ghada A. Alskait, Trad S. Alwakeel, Abdulrahman H. Zekry, Ayat A. Yousef

Saudi Arabia Department of Emergency Medicine, King Saud University, Riyadh, Saudi Arabia

Am J Case Rep 2021; 22:e930036

DOI: 10.12659/AJCR.930036

Available online: 2021-06-09

Published: 2021-07-18


#930036

BACKGROUND: Traumatic spinal cord injuries are quite common; however, a rare form of incomplete spinal cord injury is Brown-Sequard syndrome. Brown-Sequard syndrome is defined by the National Institute of Neurological Disorders and Strokes as “a rare neurological condition characterized by a lesion in the spinal cord which results in weakness or paralysis (hemiparaplegia) on one side of the body and a loss of sensation (hemianesthesia) on the opposite side.”
CASE REPORT: A 33-year-old man was brought to the Emergency Department by Saudi Red Crescent with multiple stab wounds on the left upper thoracic and lower cervical regions. He was tachycardic, but otherwise vitally stable. His Glasgow Coma Scale score was 15. The patient presented with bilateral lower limb weakness, more on the ipsilateral (left) side, and contralateral (right) hypoesthesia from the level of the nipple below. Cervical and thoracic magnetic resonance imaging revealed ligamentous injury defect at the posterior dura and indicating a dural tear with minor cerebrospinal fluid leak. Focal hyperintense signal intensity was noted on the left side of the spinal cord, representing contusion. The patient was managed conservatively with daily physical therapy. Strength had improved substantially by the time of discharge and sensation was improving.
CONCLUSIONS: Brown-Sequard syndrome is associated with good prognosis. These patients require a multidisciplinary approach because it provides the best chance of recovery to pre-injury status. These injuries may cause disastrous neurological deficits; therefore, preventive strategies should be designated to decrease the incidence of such injuries.

Keywords: Brown-Sequard syndrome, Spinal Cord Injuries, Wounds, Stab



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