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Review of the literature with case illustration. Non-missile penetrating spinal injury (NPSI) represents a small subset of spinal cord injuries at tertiary trauma centers and is comprised mostly of knife violence. Strict guidelines for the management of penetrating spinal cord injury remain elusive given the variability of mechanisms, rarity of clinical experience, and paucity of prospective studies. A review of the literature was conducted by search of the National Library of Medicine (PubMed) in the English language through June of 2018. Additional articles were culled from the reference lists of the included series. Eleven case series totaling 1007 patients, along with 21 case reports, were identified. In summary, magnetic resonance imaging (MRI) may be beneficial in assessing incomplete or progressive spinal injuries and can be considered with retained foreign bodies in select cases. Forty-eight hours of antibiotic prophylaxis is likely sufficient to prevent infection. Puncture wounds should be debrided, washed, and closed. Retained foreign bodies should be removed in the operating room and often require laminectomy. Early intervention is preferred. Non-missile penetrating spinal injury has a higher likelihood of neurologic recovery as compared to other traumatic spinal injuries. [ABSTRACT FROM AUTHOR]

Purpose: Cervical spontaneous intradural disc herniation (IDH) is an extremely rare condition. We describe a unique case of a patient presenting with a Brown-Séquard syndrome (BSS) and Horner's syndrome (HS). This study aimed to report an unusual case of spontaneous cervical intradural disc herniation that presented with Horner's and Brown-Séquard syndrome (BSS) and discuss difficulties in preoperative diagnosis and treatment difficulties of intradural cervical disc.Methods: Notes and images review, and analysis of the relevant literature.Results: A 45-year old female presented with acute Horner's syndrome and Brown-Séquard syndrome. The magnetic resonance imaging of cervical spine revealed C4-5 disc extrusion with cord compression. The patient underwent urgent decompression through an anterior cervical corpectomy and fusion. Patient fully recovered 6 months after disease onset.Conclusion: We would like to emphasize that prompt and anterior cervical decompression is the treatment of choice, as it directly address the problem and allows dura repair in spontaneous cervical disc herniation. [ABSTRACT FROM AUTHOR]

Background: Spinal cord herniation following surgery is an extremely uncommon clinical condition with very few reports in published literature. This condition usually occurs as a spontaneous idiopathic phenomenon often in the thoracic spine or following a scenario of post traumatic spinal cord/nerve root injury. Rarely has it been reported following spinal cord tumor surgery.Purpose: To document a case of cervical spinal cord herniation as a late onset complication following spinal cord tumor surgery with an atypical presentation of monoparesis.Design: Case report.Methods: We describe the clinical presentation, operative procedure, post operative outcome and review of literature of this rare clinical condition.Results: A 57-year-old man presented with right upper limb monoparesis due to a spinal cord herniation 6 years after a cervical intradural meningioma excision. The patients underwent surgery to reduce the herniation and duroplasty with subsequent complete resolution of symptoms.Conclusions: Spinal cord herniation must be considered as differential diagnosis in scenarios of spinal cord tumor excision presenting with late onset neurological deficit. These cases may present as paraparesis, Brown-sequard syndrome and rarely as in our case as monoparesis. [ABSTRACT FROM AUTHOR]

Introduction: Brown-Sequard syndrome is an incomplete spinal cord lesion characterized by ipsilateral loss of motor function and contralateral loss of pain and temperature sensitivity, reflecting a hemi-compression or hemi-section of the spinal cord. Cervical disc herniation is an exceptional cause of this syndrome. Material and methods: We report a case of cervical disc herniation causing Brown-Sequard syndrome in a patient with an unusually rapid neurological deterioration associated to cervical extension, which was documented by neuromonitoring. Conclusion: A prompt diagnosis, followed by spinal cord decompression should be warranted. Intraoperative neuromonitoring is a useful tool in preservation of neurologic function in these cases. [ABSTRACT FROM AUTHOR]

Introduction: Spinal stab wound injuries are quite rare and only few patients have been reported on the basis of MRI scan. Methods: A 25-year-old man was stabbed at C1/2 and had an incomplete Brown-Sequard syndrome. He underwent surgical exploration because of CSF leakage on the fourth day. Results: After a follow-up period of 32 months, he was left with a remaining loss of the proprioception of the right foot. We show detailed CT and MR images with the focus on the lesions of the dura and myelon and compared them with intraoperative images. In addition, we contrast our findings with a review of literature published over the last three decades. Conclusion: MRI gives the most detailed view of soft tissue lesions in SSWs and is in accordance with our intraoperative findings. [ABSTRACT FROM AUTHOR]

Treadmill training has been used as a promising technique to improve overground walking in patients with spinal cord injury (SCI). Previous findings showed that a gait pattern may adapt to a force perturbation during treadmill training and show aftereffects following removal of the force perturbation. We hypothesized that aftereffects would transfer to overground walking to a greater extent when the force perturbation was resisting rather than assisting leg swing during treadmill training. Ten subjects with incomplete SCI were recruited into this study for two treadmill training sessions: one using swing resistance and the other using swing assistance during treadmill stepping. A controlled resistance/assistance was provided to the subjects' right knee using a customized cable-driven robot. The subjects' spatial and temporal parameters were recorded during the training. The same parameters during overground walking were also recorded before and after the training session using an instrumented walkway. Results indicated that stride length during treadmill stepping increased following the release of resistance load and the aftereffect transferred to overground walking. In contrast, stride length during treadmill stepping decreased following the release of assistance load, but the aftereffect did not transfer to overground walking. Providing swing resistance during treadmill training could enhance the active involvement of the subjects in the gait motor task, thereby aiding in the transfer to overground walking. Such a paradigm may be useful as an adjunct approach to improve the locomotor function in patients with incomplete SCI. [ABSTRACT FROM AUTHOR]

Brown-Sequard syndrome (BSS) is a rare form of severe myelopathy characterised by a clinical picture reflecting hemisection of the spinal cord. This syndrome is mostly due to a penetrating injury to the spine but many other non-traumatic causes have been described. Intradural thoracic disc herniation (TDH) is one of the rare aetiologies of this syndrome. Despite progress in imaging techniques, diagnosis and treatment remain difficult. We retrospectively reviewed one of the largest reported series of six patients with BSS revealing intradural TDH between 2003 and 2007. There was a marked female predominance and the mean age was 44 years. Before surgery, half of the patients had a severe neurological deficit. The mean duration of symptoms until surgery was 8.5 months (range 0.5-24 months). Spine magnetic resonance imaging (MRI) or spine computer tomography scan showed calcified TDH between T5-T6 and T9-T10. The intradural location of the thoracic herniation was strongly suspected from the clinical data. All the patients underwent posterolateral transpedicular surgery with an operative microscope to open the dura mater. The intradural location of the herniation was overlooked in one case and the patient underwent a second procedure. The dura mater was carefully closed. Two patients' condition worsened immediately after the surgery before slowly improving. All the other patients improved their neurological status immediately after the surgery and at 12 months follow-up. BSS with TDH on the spine MRI scan may be a warning symptom of the intradural location of the herniated disc. In such cases, spine surgeons are advised to use an operative magnification and to open the dura mater to avoid missing this potentially curable cause of severe myelopathy. [ABSTRACT FROM AUTHOR]

Study design:Case report.Objective:To report three cases of Brown–Sequard syndrome (BSS) associated with cervical disc herniation.Method:We describe clinical and radiographic review of three patients who presented with BSS caused by cervical disc herniation. Three patients presented with ipsilateral motor weakness and diminished sensation to pain and temperature on the contralateral side. Magnetic resonance images of the cervical spine in all cases, showed a large paramedian disc herniation at C5–C6, with ipsilateral severe spinal cord compression. Microsurgical removal of the herniated disc via anterior foraminotomy was performed and complete decompression of the spinal cord was achieved.Results:Postoperatively, the neurological symptoms recovered rapidly with a complete remission of their symptoms.Conclusion:Although BSS is rarely associated with degenerative cervical spine disease, cervical disc herniation should be kept in mind and prompt evaluation is indicated. Anterior foraminotomy suffices for spinal cord decompression with improvement of the neurological function.Spinal Cord (2007) 45, 744–748; doi:10.1038/sj.sc.3102025; published online 6 February 2007 [ABSTRACT FROM AUTHOR]

Study design:Case report.Objective:To present an unusual traumatic neurologic pathology caused by gunshot injury.Setting:Spine unit of Department of Trauma and Orthopaedic Surgery, University Medical School, Charité – Campus Benjamin Franklin, Berlin, Germany.Method and result:A 35-year-old male sustained a gunshot injury from a machine gun. The projectile caused a fracture of the left pedicle of Th10. The spinal cord was indirectly damaged by cavitation that caused a Brown-Séquard syndrome (BSS). After a microscopically assisted posterior revision at T9/10 with removal of bullet and bone fragments from the spinal canal and debridement of the bullet cavity via extended fenestrectomy the patient gained his motor function back. The sensory deficit remained unchanged.Conclusion:BSS can be caused by bullet-related injury of the spinal canal with no direct damage of neural structures. The initial treatment is always based on the total injury pattern. Possible spinal cord injuries are only clarified after restitution of vital functions. Decompression of neural structures in shotgun injury is indicated in incomplete paraplegia, injury of intra-abdominal hollow organs or high velocity bullet wounds. Through debridement and decompression of neural structures and chronic damage caused by foreign body granulomas can be prevented. Secondary destabilization of the spine should be avoided.Spinal Cord (2007) 45, 579–582; doi:10.1038/sj.sc.3101986; published online 14 November 2006 [ABSTRACT FROM AUTHOR]

Brown-Sequard syndrome (BSS) is a unilateral cord injury characterised by an ipsilateral motor deficit with contralateral pain and temperature hypoaesthesia. Although there are a variety of causes, the majority of cases are generally of neoplastic origin or are traumatic in origin. We describe a rare cause of Brown-Sequard syndrome as a result of post-traumatic arachnoiditis. Magnetic resonance imaging with the use of thin-slice high-resolution constructive interference in steady state (CISS) and T2-weighted spin-echo sequence were used to demonstrate the cause and appearance of the lesion in the spinal canal and was useful in the assessment and management of the patient. This case illustrates the usefulness of the CISS sequence in MRI for elucidating arachnoiditis. [ABSTRACT FROM AUTHOR]

We report a patient with a Brown-Séquard syndrome who developed ventral transdural spinal cord herniation, showing the imaging findings changing over time from two thoracic disc protrusions with a normal spinal cord to a cord trapped within a bony defect in a thoracic vertebra. [ABSTRACT FROM AUTHOR]

An unusual case of damage to the cervical spinal cord due to a non-missile penetrating injury through an anterior route in a nine-year-old boy who fell from a bicycle is reported. There was a cerebrospinal fluid leak that lasted for two days. Clinical picture was that of incomplete Brown-Séquard syndrome and flaccid paresis of the extensor muscles of the left elbow and wrist. Treatment was conservative, with a very good functional recovery. To our best knowledge there is no myelographically documented case report of such a lesion in the literature. [ABSTRACT FROM AUTHOR]

Venous hypertension and stagnant hypoxia in the human spinal cord are poorly understood. We report a case in which a partial Brown-Séquard syndrome resulted from obstruction of venous drainage on one side of the spinal cord. Neurological deterioration and eventual recovery paralleled the formation and clearance of oedema. The clinical and MRI findings support the contention that spinal cord injury arising as a result of obstruction to venous outflow occurs primarily in the white matter, spreading secondarily to the grey matter, and observations that obstruction of venous flow in the high cervical spinal cord results in changes in the lower cervical cord. [ABSTRACT FROM AUTHOR]

Severe neurological deficits directly related to intraoperative injury of the spinal cord and the nerve roots is rare complication of anterior interbody fusion (AIF) in cervical spondylosis. A case of radiculopathy and Brown-Séquard Syndrome caused by a bone fragment following AIF in which a late anterior decompression and fusion of the cervical spine was performed four years after the initial operation is presented. Immediate relief of the radicular pain, improvement of the spasticity, and better spincter control could be achieved. Therefore, patients with chronic anterior compression of an incomplete spinal cord injury after AIF may benefit from a late anterior decompression and fusion. [ABSTRACT FROM AUTHOR]

Injuries in children are one of the most frequent causes of high morbidity and mortality, and they present a challenge to the treating physician. Fortunately, spinal trauma in pediatric patient is relatively rare. Brown-Séquard syndrome is a rare form of incomplete spinal cord injury consisting of ipsilateral upper motor neuron paralysis (hemiplegia) and loss of proprioception with contralateral pain and temperature sensation deficits resulting from hemisection or lateral injury to the spinal cord. A 11-year-old girl was admitted to our Pediatric Trauma Emergency Department after she had suffered a penetrating back injury. Neurological examination demonstrated left lower extremity paresis and moderate spastic paralysis of the right lower extremity. The examination showed loss of temperature sensation contralateral to and below the lesion. The examination of the pain sensation was difficult because the patient was in pain shock, but it was diminished on the side opposite to the damage. Multislice spiral computed tomography (MSCT) demonstrated a triangular foreign body in spinal canal at the level of the Th11–Th12. After a Th 11–L 2 laminectomy and retrieval of foreign bodies, dura repair was performed. Patient was discharged from the hospital with partial recovery. Operative decompression of the neural elements in case of spinal canal compromise is the treatment of choice. Indication for surgical intervention in existing cerebrospinal fluid fistula includes closure of the dura and reducing neural elements compression and lowering the risk of infectious complications by removing bone or foreign body fragments. Patients with Brown-Séquard syndrome have good prognosis for functional recovery. [ABSTRACT FROM AUTHOR]

Study design:A case report.Objectives:To present a case of postpartum hypogalactia in a woman with Brown-Séquard-plus syndrome (BSPS).Setting:Outpatient spinal cord injury (SCI) clinic.Case report:A 33-year-old woman with C4 AIS D tetraplegia (American Spinal Injury Association Impairment Scale) was followed at the outpatient SCI clinic for the past 5 years. Her right side presents with increased tone, increased spasticity and decreased sensitivity to light touch. Conversely, her left side presents with minimal changes in tone and no motor function deficits, but decreased sensitivity to pinprick and temperature sensation. These findings are consistent with BSPS. After inpatient rehabilitation, she was engaged, married, and 8 months ago delivered a healthy child. After an uncomplicated delivery, breastfeeding was attempted, but a significant lack of lactation was noted the first month postpartum from the right breast. Despite the implementation of measures to increase lactation, the lack of lactation from the right breast persisted, and required initiation of formula feeding. The right breast in this case lost not only sensory proprioception, but also autonomic control, which could contribute to this instance of asymmetric lactation.Conclusion:In addition to motor and sensory dysfunctions following SCI, autonomic dysfunctions are commonly seen in individuals with these devastating injuries. The lactation on the right side, which had interrupted descending spinal autonomic pathways, was decreased by approximately 83%. This case provides us with interesting information regarding attention that clinicians should be paying when discussing the breastfeeding options for women with SCI. [ABSTRACT FROM AUTHOR]

Study design:Case report.Objective:To demonstrate the utility of diffusion tensor imaging and tractography in two patients with Brown-Sequard syndrome after penetrating cervical cord injury.Setting:Milwaukee, WI, USA.Methods:Two patients, who presented with features of Brown-Sequard syndrome after sustaining stab wounds to the neck, underwent DTI and tractography of the cervical cord within a week of the injury. DTI metrics were measured within the left and right hemicord around the level of injury. Diffusion tensor tractography was performed to visualize the site of injury and injured fiber tracts.Results:Axial fractional anisotropy maps at the site of injury showed unilateral damage to the cord structure, and FA was significantly reduced within the injured hemicord in both patients. Tractography allowed for visualization of the injured fiber tracts around the level of injury. Both DTI metrics and tractography showed an asymmetry that corresponded to the neurological deficits exhibited by the patients.Conclusion:This report illustrates the utility of DTI and DTT in delineating regions of cord injury in two patients with traumatic Brown-Sequard syndrome. Our results indicate that DTI provides clinically relevant information that supplements conventional MR imaging for patients with acute SCI. [ABSTRACT FROM AUTHOR]

Study design:Case report.Objectives:To report an unusual case of Brown-Sequard syndrome (BSS) associated with idiopathic transverse myelitis (TM).Setting:Department of Neurosurgery, Chonnam National University Hospital, Gwangju, South KoreaMethods:A 38-year-old man presented with left leg weakness and right-sided decrease in sensation at the T11 level below. Magnetic resonance images (MRI) of the thoracic spine showed diffuse swelling of the spinal cord spanning the fifth to the eighth thoracic vertebra. The lesion had high signal intensity on T2-weighted images. Eccentric nodular enhancement within the left anterolateral aspect of the spinal cord was appreciated with gadolinium administration.Results:The patient was treated with pulsed methylprednisone and showed marked improvement in neurological function within 3 days. An MRI at 5-month follow-up demonstrated complete resolution of the abnormalities.Conclusion:This case illustrates a rare case of BSS caused by idiopathic TM of the thoracic spinal cord. TM should be considered in the differential diagnosis of BSS.Spinal Cord (2009) 47, 176–178; doi:10.1038/sc.2008.23; published online 11 March 2008 [ABSTRACT FROM AUTHOR]

After a lower hemi-cervical spinal cord injury, a patient presented with a left hemiplegia and on the same side a unilateral chest wall paradoxical motion mimicking a flail chest. X-rays demonstrated a left hemilateral C6 injury but no rib fractures. We demonstrated that the paradoxical motion was due to the action of the diaphragm acting on the rib cage with intercostal respiratory paralysis on the side of hemiplegia. [ABSTRACT FROM AUTHOR]

Radiation-induced myelopathy is often a diagnosis of exclusion. In addition to the classic criteria needed to support the diagnosis, the presence of another radiation-induced lesion, such as aseptic vertebral necrosis, is useful to confirm the cause of the spinal cord lesion. [ABSTRACT FROM AUTHOR]

Study design:Several causes of Brown-Sequard syndrome have been described. Endovascular embolization can be used to treat symptomatic vertebral hemangiomas. We describe a previously undocumented case of Brown-Sequard syndrome followed by endovascular embolization with microcoils of a vertebral hemangioma. We also provide a clinical-radiological correlation of this finding and review the relevant literature.Case report:A 39-year-old male was referred to our hospital for endovascular treatment of a right T9 hemivertebral hemangioma with compromise of the spinal canal. Fifteen minutes after the procedure, the patient developed right lower limb weakness and numbness on the left leg. The emergency magnetic resonance imaging (MRI) of the spine showed no abnormalities. Five days later, a new spinal MRI revealed an infarction in the right half of the spinal cord at T6 and T7 level. This stroke was probably caused by a microcoil ended up in the right sulcocommisural artery. One week after surgery, the patient was able to raise the right leg against gravity, but sensory deficit showed no improvement.Conclusions:To the best of our knowledge this is the first case of a Brown-Sequard syndrome related to vertebral hemangioma embolization, a relatively safe technique with no important complications made known until this report. Clinicians should always weight the benefits with the potential devastating complications of this therapeutic option. [ABSTRACT FROM AUTHOR]

Objective:To report on an unusual knife stab injury of the thoracic spine, causing an acute subdural haematoma (SDH) and paraparesis.Setting:Department of Surgical Neurology, Ward 20, The Royal Infirmary of Edinburgh.Case report:The weapon was a knife, which traversed the mid-thoracic spinal region, causing an incomplete spinal cord lesion, which was demonstrated by myelography to be due to an SDH. The haematoma was removed at operation. There was a full neurological recovery.Conclusion:There was no bony injury. The likely cause for the development of the SDH was believed to be due to the sudden impingement on the spine by the weapon, rupturing small subdural veins.Spinal Cord (2005) 43, 678–679. doi:10.1038/sj.sc.3101765; published online 26 April 2005 [ABSTRACT FROM AUTHOR]

N. Liu and A. V. Krassioukov reply to a letter to the editor submitted in response to their article "Postpartum Hypogalactia in a Woman With Brown–Séquard-Plus Syndrome: A Case Report", which appeared in a 2013 issue.