The Brown-Sequard syndrome is a rarely occurring disease that occurs normally by spinal cord injuries. The patient can perceive neither pain nor temperature on one side of the body. Only rarely is it the so-called pure Brown-Séquard syndrome; in many cases there is an incompletely developed form of the syndrome.
What is Brown-Séquard Syndrome?
Brown-Séquard syndrome is a so-called symptom complex that occurs in the context of unilateral damage to the spinal cord. This leads to muscle paralysis and dissociated disorders of sensitivity. The Brown-Séquard syndrome was first documented between 1850 and 1851 by Charles-Édouard Brown-Séquard; Brown-Séquard syndrome occurs mainly after injuries or contusions to the spinal cord.
Sometimes a tumor in the spinal canal can also be responsible for the development of Brown-Séquard syndrome. The spinal cord consists of ascending sensory and descending motor nerve tracts, which can also switch to the other side of the marrow.
If there is damage, a diffuse clinical picture arises – unlike with total paraplegia – while paralysis occurs on one side, the patient perceives disturbances in pain, pressure and temperature perception on the other.
Causes
Brown-Séquard syndrome is extremely rare. There are many reasons why Brown-Séquard syndrome can develop: Brown-Séquard syndrome mainly arises from a blunt or penetrating injury, from sub- or epidural hematomas of the spinal cords or from herniations of the intervertebral discs.
Local primary tumors or metastases can also be responsible for the development of Brown-Séquard syndrome. The cause is essential for further treatment. For this reason, the physician must recognize in advance which reasons were responsible for Brown-Séquard syndrome at all.
A spontaneous occurrence is de facto not possible. Occasionally acute symptoms can occur, whereby these predominantly indicate a tumor. As a rule, however, the syndrome only occurs in connection with existing injuries to the spinal cord.
Symptoms, ailments & signs
The Brown-Séquard syndrome manifests itself primarily through neurological functional failures. The doctor differentiates between motor and sensitive failures. One of the motor failures is the ipsilateral spastic leg parasis, which occurs due to damage to the pyramidal tract (corticospinal tract).
Sensitive functional failures include the so-called epicritical sensitivity of the ispilateral side when damage has occurred in the posterior pulmonary tract. There is also a loss of pain and temperature perception, whereby the medical professionals speak of a dissociated sensory disorder.
The vegetative symptoms include redness and overheating of the skin; in some cases a lack of sweat secretion was also documented. So at the beginning the patient notices a one-sided paralysis, but notices that he cannot perceive either temperature or pain on the other side of the body.
Such symptoms, in connection with the existing and known medical history, must therefore in no way be ignored or postponed. If there is a possibility that Brown-Séquard syndrome is involved, a medical professional must be contacted immediately.
Diagnosis & course
The pure Brown-Séquard syndrome is a rarity. In almost all cases, medical professionals document an incomplete form of the syndrome; Occasionally – due to other injuries – further symptoms and complaints can occur that are by no means typical of Brown-Séquard syndrome. The physician must therefore carry out neurological examinations, whereby the corresponding tests of the motor skills come to the fore.
Furthermore, the doctor checks the depth and surface sensitivity, the patient’s sense of temperature and tries to determine the location of the lesion level based on the loss of sensitivity. Imaging methods are used as support to secure the diagnosis.
These are mainly X-rays, magnetic resonance tomographies and computed tomographies. As part of the imaging tests, it is possible that the cause of the lesion and its extent can be identified. Such diagnoses are mainly made by medical specialists; it is therefore advisable to seek advice from a doctor who specializes in the subject of spinal cord injuries.
When should you go to the doctor?
In general, Brown-Séquard syndrome does not require an additional doctor to be diagnosed. In most cases, the diagnosis is made in the hospital, as the affected person can no longer feel or move parts of the body. However, a doctor should be consulted if paralysis or sensitivity disorders occur suddenly or without special injuries.
Sudden reddening of the skin or the inability to perceive temperature differences can also indicate Brown-Séquard syndrome and should definitely be treated by a doctor. A doctor must be consulted, especially after accidents, blows or falls. Insensitivity to pain is also a decisive signal that can indicate this disease.
The diagnosis of Brown-Séquard syndrome is made by a general practitioner or with an MRI. This also makes it easy to diagnose the causes of the sensory disturbances. Further treatment depends heavily on the cause. If it is a tumor, it can be removed. In the case of irreversible injuries, therapy can no longer be carried out.
Treatment & Therapy
If the doctor determines that a tumor is pressing on the patient’s spinal cord, surgery can remove the tumor and thus alleviate Brown-Séquard syndrome. If acute symptoms arise that suggest that it is a so-called mechanical spinal cord compression, the person affected is operated on immediately.
Even if an operation does not always improve the neurological situation, it does make the subsequent course of treatment easier. Follow-up care and remobilization also lead to better results when the doctor operates on the patient. After the operation, it is important that the patient use physiotherapy.
A cure is not possible. Ultimately, the surgical treatments and rehabilitation measures serve to improve symptoms. The aim is that the patient – after surgery and rehabilitation – can move around independently with aids.
Outlook & forecast
In many cases, Brown-Séquard syndrome cannot be treated. This is especially the case when the syndrome occurs as a result of an injury to the spinal cord. In this case, the injury can no longer be corrected, so that the patients suffer from limitations throughout their lives.
In the case of a tumor, it can be removed. However, the further course depends very much on where the tumor is located and whether it has already metastasized. In the case of metastasis, the life expectancy of the patient is significantly reduced and thus the patient dies prematurely.
Even after successful removal of the tumor, the patient often has to rely on various physical therapy measures to restore movement. This allows the person affected to move independently.
If no treatment is given for Brown-Séquard syndrome, the condition of the person concerned remains the same or worsens if the tumor is the cause of the disease. Self-healing does not occur. If Brown-Séquard syndrome occurs as a result of an accident, most of those affected will also suffer from other injuries or illnesses.
Prevention
Because Brown-Séquard syndrome develops due to injuries or tumors, prevention is not possible. It is advisable to contact a health professional immediately if symptoms suggestive of Brown-Séquard syndrome occur. Earlier treatment can subsequently lead to faster rehabilitation of the person concerned.
Aftercare
Follow-up care options are usually very limited in Brown-Séquard syndrome. The syndrome itself can only be treated symptomatically and not causally, as it is a genetic disease. With this syndrome, the affected person is always dependent on an operation to alleviate the discomfort in the back.
After the procedure, the patient needs rest and rest. Avoid unnecessary burdens. If the reason for the Brown-Séquard syndrome is a tumor, further and, above all, regular examinations by the doctor for further tumors can be very useful. Physiotherapy measures are also necessary after the surgical procedure in order to restore the affected person’s complete movement.
Many of the exercises from physiotherapy can also be performed in your own home and with the help and support of friends or family, so that healing is accelerated. However, the person affected cannot always move around on their own and is usually still dependent on other aids in everyday life.
The life expectancy of the person affected is not negatively influenced by Brown-Séquard syndrome. In some cases, psychological treatment may also be necessary or useful for this syndrome if depression or other mental disorders occur.
You can do that yourself
The motor restrictions of Brown-Séquard syndrome can only be reduced surgically. Since a cure is not possible, the therapy is symptomatic. Everyone affected can take action themselves.
After the mostly performed operation, patients should constantly take part in the prescribed physiotherapy. Only if those affected repeat the exercises at home are there a good chance of a satisfactory remobilization. Furthermore, all postoperative measures such as physical restraint, avoidance of stress, regular stays in the fresh air, a diet rich in vital substances and a healthy lifestyle are very beneficial for the healing process.
Since symptoms of paralysis and the prospect of a life in a wheelchair are considered to be psychologically very stressful for those affected, accompanying psychotherapy is also advisable. In addition, self-help groups – contacts can be established via the Internet or the treating doctor – can represent a platform for exchanging experiences.
Even if the operation often restores mobility to those affected, neurological disorders persist. Due to the lack of pain and temperature sensitivity, caution is advised in everyday life. Those affected should ensure adequate heat and skin protection through adequate clothing so that no hypothermia or overheating occurs. If there is no sweat secretion, sufficient cooling should be ensured.
Possible sources of injury in the household must also be checked. Patients have to learn a new body awareness and train their awareness of their physical needs. A combination of physiotherapy and psychotherapy can also help here.
