Search

Brown-Sequard syndrome is an incomplete spinal cord lesion characterized by hemisection injury of the cord. We present a case of pregnancy, delivery and postpartum course following this rare neurological condition. A 42-year-old woman presented with past history of idiopathic hemicord myelitis leading to right sided hemiplegia with decreased contralateral sensation of pain and temperature, consistent with Brown-Sequard syndrome, which was treated with steroids and Therapeutic Plasma Exchange. Thereafter, she had near-complete motor recovery and complete sensory recovery over the next 3months. Three years later, she presented to us at 37+2 weeks of gestation with residual hemiparesis with motor power grade of 4/5 in right upper and lower limbs. She underwent Caesarean section for breech presentation, which was done under general anaesthesia in view of prior spinal cord lesion. She was discharged for follow-up in Neurology outpatient clinic and physical rehabilitation. At follow up after 12 months of delivery, she had complete motor and sensory recovery. Management of spinal cord lesions in pregnancy and delivery requires specialist multidisciplinary care due to risk of medical and obstetric complications. This case demonstrates a rare scenario of a primigravida at term gestation with residual deficits of a past spinal cord lesion. Keywords: Brown-Sequard syndrome, Case report, Hemicord myelitis, Hemiparesis, Pregnancy.

Myelitis, including longitudinally extensive transverse myelitis (LTEM), is reported in more than forty patients after coronavirus disease 2019 (COVID-19). Among COVID-19 vaccines, only Oxford-AstraZeneca COVID-19 vaccine (AZD1222) has been associated with few cases of myelitis (1 LTEM). We report the first case of myelitis/LTEM after BBIBP-CorV/Sinopharm vaccine, interestingly presented as a hemicord syndrome. A 71-year-old male presented with left-side diplegia, right-side hemihyposthesis with facial sparing and impaired position sensation in left foot after vaccination with BBIBP-CorV. MRI revealed a longitudinal signal in left cervical hemicord. This is the first reported myelitis and LTEM with COVID-19 vaccines other than AZD1222.

Background and Importance: Brown-Sequard Syndrome (BSS) is a rare neurological condition resulting from a hemisection injury to or unilateral compression on the spinal cord. The common causes of BSS that are amenable to be treated surgically can be divided into traumatic and non-traumatic injuries. Traumatic injuries are often reported as the main cause of BSS. However, non-traumatic injuries of the spinal cord are more seen in recent years. This study aims to classify and update surgically treatable causes of BSS. Case Presentation: Retrospective data of 17 patients operated for BSS between 2008 and 2020 were included. The long-term outcomes of these patients were evaluated. In addition, a comprehensive search in PubMed, Scopus, and CINAHL was conducted for the retrieval of all relevant studies. Results: Magnetic Resonance Image (MRI) of our patients revealed Cervical Disc Herniation (CDH), spinal canal stenosis with cervical spondylosis, epidural hematoma, and ossification of the posterior longitudinal ligament. The postoperative outcomes of our cases ranged from partial to complete recovery. While the patients with acute epidural hemorrhage achieved complete recovery after surgery, neurological deficits in the other patients, especially those with severe cervical spinal canal stenosis, persisted despite adequate surgical decompression. The systematic literature review revealed that CDH is the most common non-traumatic surgically treatable cause of BSS, followed by spinal cord herniation and spinal epidural hematoma. Conclusion: Non-traumatic injuries of the spinal cord accompanied by narrowed cervical spinal canal pathologies are prominent surgically treatable causes of BSS. Contrary to the definition made 100 years ago, BSS can occur spontaneously due to underlying pathologies rather than major traumatic injuries.

Incomplete spinal cord injury is challenging to diagnose and treat. This overview of Brown-Sequard syndrome outlines key assessment and nursing considerations important to enhancing recovery outcomes.

Background: Several case reports about spinal cord compression due to hyperostosis at the craniocervical junction are available. However, compression at C1-C2 solely due to ossification of the posterior longitudinal ligament (OPLL) is rare. Case Description: A 50-year-old Asian male, with a history of lumbar spinal canal stenosis, presented with a progressive quadriparesis within 3 months. Imaging showed central OPLL at the C1-C2 level contributing to severe spinal cord compression. The patient improved neurologically after a C1-C2 laminectomy. Conclusion: A patient presented with a progressive Brown-Séquard syndrome due to OPLL at the craniocervical junction (C1-C2 level) and improved following a decompressive laminectomy.

Fibrocartilaginous embolism (FCE) is a rare and probably under diagnosed cause of spinal cord infarction presumably due to acute embolization of nucleus pulposus fragments into the spinal circulation. Concomitant cerebral involvement is much rarer and often asymptomatic. Although the definitive diagnosis is histologic, certain criteria have been proposed to support the diagnosis in living patients, such as absence of vascular risk factors, acute onset or antecedent of valsalva maneuver before the episode and the exclusion of potential differential diagnoses. A 56 years-old patient, without any medical history was referred for sudden back pain while carrying heavy load at work. Clinical examination showed a Brown-Sequard syndrome. Brain and spine MRI disclosed spinal cord infarction at the C4-C5 level associated with brain infarctions involving exclusively the vertebrobasilar circulation. The exhaustive etiological assessment was normal. In our case, the acute symptoms onset, the clinical and imaging data and lack of evidence for other plausible diagnoses in the setting of a valsalva-like maneuver are highly suggestive of FCE diagnosis.

Brown-Sequard Syndrome is a neurologic disorder caused by partial spinal cord injury and disruption of the corticospinal tract, dorsal columns, and spinothalamic tract. We present a 32-year-old male with partial T11-12 cord transection due to a penetrating knife injury. In addition to the classical neurological symptoms of Brown-Sequard Syndrome, he also exhibited ipsilateral peripheral vasodilatation below the level of injury. This finding is attributed to the disruption of the intermediolateral columns of the spinal cord and impaired sympathetic tone on the peripheral vasculature. Awareness of this finding can raise the radiologist's suspicion for spinal cord injury in the setting of trauma and peripheral vasodilation.

Late-onset Brown-Sequard syndrome (BSS) is a rare condition resulting from a spinal cord injury that develops weeks to years after a blunt trauma. Acute-onset BSS after a blunt injury has been rarely reported. Here, we report on a case of BSS, in a 58-year-old man, that developed immediately after a motor vehicle accident. Upon admission, loss of right thoracic motion, complete right paresis, and loss of pain and temperature sensations below the C3 level on the left side were observed. Magnetic resonance imaging showed hyperintensities within the cervical spinal cord at the C2-C3 level, confirming the diagnosis of BSS. Thoracic motion rapidly recovered, but other neurological sequelae persisted. BSS related to cervical cord injury should be suspected when patients develop hemiparesis and contralateral sensory loss immediately after a blunt trauma. Likewise, clinicians should be aware that unilateral loss of thoracic motion could be an important sign of BSS.

Background Idiopathic spinal cord herniation (ISCH) is a treatable spinal disease. It is rare and often misdiagnosed, causing a delay in management. The etiology is multifactorial, with one of the causes being duplication of the ventral dura. The spinal cord herniates within this defect and becomes strangulated, causing neurological deficits. We report the duplication of a ventral spinal cord as an important cause of ISCH in our review. Case Description We present 2 cases of ISCH with duplication of the dura, including their relevant clinical and imaging features. The patients underwent surgical reduction of the herniated spinal cord with enlargement of the defect and placement of a dural substitute ventral to the cord. We have also reported the outcomes of the 2 patients, with an emphasis on the factors predictive of poor outcomes (i.e., long-standing symptoms, a delay in intervention, poor neurological status at presentation, and a thinned out atrophic spinal cord found during surgery). We also reviewed the available data for duplication of the dura with ISCH. Conclusions Very few asymptomatic patients can be treated conservatively. The surgical outcomes have been favorable for symptomatic patients. Proper exposure, gentle manipulation while reducing the herniated spinal cord, enlargement of the defect, and the use of intraoperative monitoring will help limit the postoperative deficits. Duplication of the ventral dura is an important cause of ISCH. It prevents the formation of an anterior pseudomeningocele after surgery. Owing to the rarity of the disease and the lack of follow-up data with recurrence rates, it has not been possible to form clear guidelines for management.

Context: Idiopathic spinal cord herniation (ISCH) remains an obscure, under recognised but potentially treatable entity among the etiologies of compressive myelopathy. Findings: Here, we present a retrospective case series of eight patients of ISCH with their clinical features, imaging findings and long-term follow up data along with a relevant review of the literature. Mean age at presentation was 36 years with the duration of symptoms ranging from two months to more than thirty years. Contrary to existing data, only two patients in our series had the classical presentation of Brown-Sequard syndrome (n = 2). The clinical spectrum of the presentation was broad with pure spastic quadriparesis (n = 3), girdle sensation (n = 1) and radiculopathy (n = 1), the latter presentation has been unreported for ISCH. The typical radiological picture was seen in all patients. All except one patient was managed conservatively. In the one patient who underwent bilateral dentate ligament excision, there was mild functional improvement on long-term follow-up despite a definite worsening of the radiological picture. Five of the patients had a long-term follow-up with no clinically or functionally significant worsening. Clinical relevance: The current study highlights the wide clinical spectrum and relatively stable natural course of ISCH and reports on hitherto undescribed presentation as radiculopathy.

BACKGROUND: Anterior thoracic spinal cord herniation (ATSCH) is a rare cause of progressive myelopathy. Early surgery is essential, but there is no agreement about the best surgical approach. OBJECTIVE: To identify factors that determine surgical results, and to find evidence for the most favorable technique to correct ATSCH. METHODS: To find relevant literature, computerized databases of PubMed, EMBASE, and ISI Web of Science were searched. The current study comprised case-reports published between 1974 and 2018, and the data-set was completed with 12 cases treated in our own institute. Patient characteristics were analyzed following the principles of an individual participant data (IPD) meta-analysis. RESULTS: Brown-Séquard-like neurological deficit prior to surgery was associated with postoperative motor-function improvement when compared to patients with para-paresis (P=0.04). In the univariate analysis, widening of the dura defect (WDD) was more prevalent among improved patients, whereas anterior dura patch (ADP) and application of Intra Operative Neurophysiological Monitoring (IONM) were not. In the multivariate analysis the favorable association with WDD disappeared, which is explained by the dominant influence of a Brown-Séquard-like deficit on outcome. CONCLUSIONS: In general, postoperative results after surgery for ATSCH are favorable, with a high percentage of patients experiencing postoperative improvement. Postoperative motor function improvement is more likely to occur in patients with a Brown-Séquard-like neurological deficit. The WDD should be favored above the application of a patch as the technique of choice in surgical treatment of ATSCH.

ispartof: CLINICAL LUNG CANCER vol:22 issue:4 pages:E552-E554 ispartof: location:United States status: published

Patient: Male, 33-year-old Final Diagnosis: Traumatic Brown-Séquard syndrome Symptoms: Bilateral lower limb weakness • contralateral (right) hypoesthesia from the level of the nipple below • knee and ankle jerks both were 2 on the right side and 0 on the left Medication: — Clinical Procedure: Magnetic resonance imaging (MRI) of the cervical and thoracic spine • whole-body computed tomography (CT) Specialty: Surgery Objective: Unusual clinical course Background: Traumatic spinal cord injuries are quite common; however, a rare form of incomplete spinal cord injury is Brown-Séquard syndrome. Brown-Séquard 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-Séquard 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.

The annual incidence of traumatic spinal cord injury worldwide is 35 patients per million; this incidence is likely to be much higher in Latin America, where stab injuries are a common incidence. Stab injuries to the spine represent a small percentage of these cases; these are rare injuries; its management may differ compared with other penetrating injuries; these injuries are frequently complicated with neurological damage; the most common clinical manifestation is Brown–Sequard syndrome, and the most common segment involved is the thoracic region; stab injuries to the lumbar spine are rarely found in the literature. The management of patients without neurological involvement is controversial due to the risk of neurologic deterioration intraoperatively. However, failure to adequately intervene increases the risk of permanent neurological deficit, worsening functional outcomes, cerebral fluid leakage and infections. A short review of the literature and a case report are presented.

Background Brown-Séquard syndrome often occurs in spinal cord injury, and few myelitis patients present with Brown-Séquard syndrome. Case presentation A 33-year-old Han man was admitted with neck pain plus numbness in the right limbs for 2 days and weakness in the left limbs for 1 day. Examination was significant for left limbs with grade 4 muscle power, positive left Babinski sign, diminished vibration sensation in the left limbs and decreased pain below the right clavicle dermatome. The cerebrospinal fluid (CSF) cell count was 24 × 106/L, and the protein count was 185 mg/L. Cervical magnetic resonance imaging (MRI) indicated abnormal swelling signals in the medulla-cervical cord long segment and enhanced signals in the C2-3 region. In the second case, a 47-year-old Han woman was admitted with weakness in the right lower limb and numbness in the left lower limb for more than 20 days. Examination was significant for the right lower limb with grade 4 muscle power, left knee hyperreflexia, positive left Babinski sign, diminished vibration sensation in the right lower limb and decreased pain below the right T2 dermatome. Cervical MRI indicated hyperintense and enhanced signals in the C7-T2 region. In these two cases, CSF culture, oligoclonal band (OB) and aquaporin 4 (AQP4) antibody were negative. Brain MRI was normal. Their symptoms and MRI results improved after treatment with methylprednisolone. Conclusions Myelitis can present as Brown-Séquard syndrome, providing an extended reference in terms of the differential diagnosis for clinical physicians.

While idiopathic ventral thoracic spinal cord herniation was first described by Wortzman et al. 4-decades ago, the pathophysiology remains a subject of significant controversy. Due to only approximately 260 cases having been described, the majority of which were managed operatively at the time of diagnosis, little is known about the natural history of the disease which confounds decision making regarding the optimal management strategy. What we do know is that epidemiological clustering occurs in middle-aged females, and that the disease has a predilection to occur in the high thoracic spine. Despite MRI imaging being the diagnostic modality of choice, misdiagnosis as a dorsal arachnoid cyst is common, and has been reported to occur in up to 45% of cases. Regarding management the attending neurosurgeon must decide whether a conservative approach with close surveillance is to be employed, bearing in mind an unknown risk of sudden neurological deterioration, or whether surgical intervention is to be employed. Regarding the actual surgical technique employed, additional considerations are whether a ventral or dorsal approach will be used, whether the defect will simply be widened to prevent spinal cord strangulation, or whether primary dural closure, or a dural patch, will be utilized. We describe an adult male patient who presented to our unit with insidiously progressive thoracic myelopathy, presenting as a Brown Sequard syndrome, secondary to idiopathic ventral thoracic spinal cord herniation. Utilizing intra-operative neurophysiological monitoring, which we advocate as a mandatory surgical adjunct in these cases, he was taken to the operating room where a laminectomy, midline dorsal linear durotomy, division of the dentate ligaments, adhesiolysis, reduction of the herniated spinal cord, dural patch closure of the ventral defect, and duropasty of the dorsal durotomy, was performed. By utilizing this combination of techniques, we report no early worsening of the patient’s neurological deficit.

Rationale: A case of traumatic atlanto-axial rotatory subluxation (AARS), dens fracture, rupture of transverse atlantal ligament (TAL), and subaxial spinal cord injury without radiographic abnormality (SCIWORA) of Brown-Sequard syndrome has never been reported in a child. Patient concerns: A 7-year-old boy presented to hospital with torticollis, neck pain, and limited neck rotation after a seat-belt injury sustained during a car accident. Neurologic examination revealed right-side motor weakness and left-side sensory abnormality, known as Brown-Sequard syndrome. Diagnosis: Radiologic examinations revealed type II AARS (Fielding and Hawkins classification), increased atlanto-dental interval (ADI) of 4.5 mm due to a type 1B TAL rupture (Dickman classification), a displaced transverse dens fracture along with an ossiculum terminale, and an intramedullary hemorrhage on the right side of the spinal cord at C3–4. Interventions: The patient immediately received methylprednisolone, and his motor weakness and sensory abnormality gradually improved. At the same time, the patient underwent initial halter traction for 2 weeks, but he failed to achieve successful reduction and required manual reduction under general anesthesia. Outcomes: At the 7-month follow-up visit, radiologic examinations showed a corrected type II AARS that was well maintained and normalization of the ADI to 2 mm. The reduced transverse dens fracture was well maintained but still not united. All clinical symptoms were significantly improved, except the remaining motor weakness of the right upper extremity. Lessons: To the best of our knowledge, this is the first report of traumatic AARS, dens fracture, TAL rupture, and subaxial SCIWORA of Brown-Sequard syndrome in a child. Appropriate diagnosis and careful treatment strategy are required for successful management of complex cervical injuries in a child.

Introduction and importance: This case report presents a rare case of vertebral artery and spinal cord injury due to air rifle pellet. Case presentation A previously healthy 19-year-old male was shot on his left neck incidentally during recreational air rifle game. He was taken to the other hospital before being referred to our hospital. Clinical findings and investigations The patient presented with total loss of motoric function on his left side of the body together with sensoric function on the contralateral side from the level of C5 and below. Signs of stroke were also spotted on the patient's face. The cervical plain radiograph and CT scan were carried out preoperatively to depict pellet fragments. Meanwhile, the CT angiography which was commenced postoperatively revealed the left vertebral artery injury. Interventions Surgery comprising of pellet fragments removal, decompression and posterior stabilization of the cervical spine was carried out to retrieve the pellet fragments, which were embedded at the posterior epidural space. Relevance and impact Our findings were consistent with the vertebral artery injury and Brown-Sequard syndrome. Hence, these clinical entities should be considered in the setting of penetrating cervical trauma.

Incomplete spinal cord syndromes are clinical syndromes that show typical clinical signs in incomplete spinal cord injuries or lesions, when injuries or lesions affect specific anatomic regions of the spinal cord, with some preservation of sensory or motor function below the lesion. The clinical presentation of the incomplete spinal cord syndromes is largely determined by the involvement of the three tracts: corticospinal tract, spinothalamic tract, and posterior column of the spinal cord. There are eight types of incomplete spinal cord syndromes based on clinical presentations: central cord syndrome, Brown-Sequard syndrome (unilateral cord syndrome), anterior cord syndrome, posterior syndrome, caudal equine syndrome, conus medullaris syndrome, subacute combined degeneration myelopathy, and cruciate paralysis. Knowledge of the spinal cord anatomy and the ability to identify the typical clinical findings of common spinal cord syndromes are essential to the examination and treatment of the patient. This chapter describes the relevant anatomy of three important white matter tracts (corticospinal tract, spinothalamic tract, and posterior columns), understanding of which is crucial in diagnosing the type of incomplete spinal cord syndrome and clinical features of incomplete spinal cord syndromes.

Objective This study aims to describe the clinical characteristics of patients with sulcal artery syndrome, and between those with vertebral artery dissection against those without. Methods We report three cases of sulcal artery syndrome without vertebral artery dissection, performed a systematic review and retrospective analysis of the characteristics of patients with sulcal artery syndrome in available literature, and compared the clinical features of those with vertebral artery dissection against those without. Results We report 3 patients with sulcal artery syndrome, and analysed them with 17 other cases identified in literature between January 1990 till April 2020. The mean age was 47 years (range 10–80), with twice as many males as females. Pain at onset was a prominent feature (17/18, 94.4%). Preceding trauma occurred in less than half (7/18, 38.9%). Most had cervical cord infarctions (18/20, 90%), often over the high cervical cord (16/18, 88.9%). Good functional recovery (mRS 0–2) was observed in 86.7% (13/15). While vertebral artery dissection was the leading aetiology (11/20, 55.5%), about half of the cases were due to other causes. Cervical cord involvement was significantly associated with vertebral artery dissection (p = 0.026). Conclusion Sulcal artery syndrome should be suspected in patients with acute hemicord syndrome, especially in males with cervical cord involvement or pain at onset. High cervical cord involvement was strongly suggestive of underlying vertebral artery dissection. Additionally, DWI sequences are useful when evaluating acute myelopathies, and its inclusion in conventional MRI sequences is supported in prevailing literature.

Brown-Séquard syndrome (BSS) is a rare neurological condition caused by a hemi-lesion of the spinal cord and was first described in the 1800s. BSS is characterized by an ipsilateral absence of motor control and discriminatory/proprioceptive/vibratory sensation at and below the spinal level involved, associated with loss of contralateral temperature and pain sensation a couple of vertebral segments below the lesion. BSS is commonly associated with trauma, but can also be iatrogenic. The authors report a case of a patient who presented with neoplastic dorsal spinal cord compression and developed a BSS after surgical decompression and review of the literature of postoperative BSS cases.

Brown-Séquard syndrome (BSS) presents as an ipsilateral loss of motor function, proprioception and vibratory sensation accompanied by contralateral pain and temperature loss two to three levels below the level of the injury. It is one of the syndromes associated with incomplete transection of the spinal cord. Classic BSS is rare as most patients present with mixed neurological deficits related to damage of the spinal cord and surrounding structures. BSS remains prevalent in areas with high trauma burden, where assaults with sharp weapons are common. We present the case of a man aged 38 years who sustained a stab injury to the left back. BSS was diagnosed. He underwent removal of the weapon in the operating room and had an uneventful recovery to near baseline functional level after a course of rehabilitation. Despite being a rare aetiology, BSS continues to be an excellent reminder to trauma providers of the anatomy and physiology of neuroanatomical tracts.

Patient: Male, 25-year-old Final Diagnosis: Acute spontaneous spinal subdural hematoma Symptoms: Weakness Medication:— Clinical Procedure: — Specialty: Critical Care Medicine • Neurology • Neurosurgery • Radiology Objective: Rare disease Background: Spontaneous spinal subdural hematoma is a rare condition that can lead to devastating neurologic deficits, usually caused by coagulation abnormalities, trauma, underlying neoplasm, or arteriovenous malformation. The patient presents with local and/or radicular pain, followed by loss of sensory, motor, bladder, and bowel function. Case Report: A 25-year-old patient presented with left-sided weakness preceded by nontraumatic upper back pain. He denied any past medical illness and being on any regular medications. He had decreased strength in the left lower limb, left upper limb, and right lower limb, with intact strength in the right upper limb. The patient exhibited decreased sensation of pain and touch on the right side of the lower limb, bilateral loss of proprioception, and intact reflexes and anal tone. He had weakness on the left side of the body and contralateral decreased sensation of pain and touch on the right side. These symptoms were suggestive of Brown-Séquard syndrome, while the bilateral loss of proprioception suggested posterior cord syndrome. Magnetic resonance imaging showed an acute spinal subdural canal hematoma producing cord compression. The patient had an urgent laminectomy and hematoma evacuation. Afterward, his neurological function improved. Conclusions: Spontaneous spinal subdural hematoma can occur without any known pathology or remarkable trauma. It can compress the spinal cord and produce cerebral stroke-like symptoms. Hence, spinal hematoma should be ruled out in any patient presenting with a neurological deficit.

Thoracic disc herniation is a rare and severe condition, whose treatment may have complications including dural tears. Although benign in most cases, dural tears may induce iatrogenic transdural herniation of the spinal cord. The video demonstrates the diagnosis and surgical treatment of iatrogenic transdural herniation of the spinal cord. Here, we report a case of spinal cord herniation after thorascopic treatment of a thoracic disc herniation (DH). A 28-yr-old male presented with several years of left lower extremity weakness and was found to have a T6-7 DH. He underwent DH resection through video assisted mini-thoracotomy at another institution. In the immediate postoperative period, he developed a Brown-Sequard syndrome with left leg weakness. The surgeon decided not to reoperate and the patient improved with rehabilitation, allowing him to walk again. At 6 mo postop, he experienced sudden neurologic worsening but did not present to our clinic until 6 mo later. At this time, he had near complete paraplegia with bilateral lower extremity spasticity and central neuropathic pain. MRI showed a pseudo-meningocele and features suggesting a lateral spinal cord herniation. After a multidisciplinary meeting, we elected to perform a posterolateral approach with costo-arthro-pediculectomy and durotomy to repair the SC herniation. Immediately postop, the patient had a slight improvement in right lower extremity function, with decreased pain and spasticity. This case shows a transdural SC herniation, a rare complication after resection of DH. It is possible that an unreported or unrecognized dural tear at the time of the initial surgery, combined with the negative pressure of the thoracic cavity, put the patient at risk for this particular complication. The authors state that the patient gave his informed consent.

Idiopathic spinal cord herniation is a rare cause of progressive myelopathy that can result in severe disability. In the following report, an illustrative case and associated video in the surgical management of ventral thoracic spinal cord herniation is presented and discussed. Spinal cord herniation is most commonly observed in the thoracic spine and is characterized by ventral displacement of the spinal cord through a defect in the dura. Over time ventral herniation of the spinal cord can compromise its vascular perfusion, resulting in further ischemic injury. The etiology is unclear, but suspected to be either acquired or congenital. Multiple surgical techniques have been reported with the goal of detethering the cord and taking adjunctive measures in reducing the risk for re-herniation. Surgical management of thoracic spinal cord herniation carries great risks, although neurological outcomes are generally favorable with improvements reported in the majority of cases.

Study Design: Retrospective case study on prospectively collected data. Objectives: The purpose of this explorative study was: 1) to determine if patterns of spinal cord injury could be detected through intra-operative neuromonitoring (IONM) changes in pediatric patients undergoing spinal deformity corrections, 2) to identify if perfusion based or direct trauma causes of IONM changes could be distinguished, 3) to observe the effects of the interventions performed in response to these events, and 4) to attempt to identify different treatment algorithms for the different causes of IONM alerts. Methods: Prospectively collected neuromonitoring data in pre-established forms on consecutive pediatric patients undergoing coronal spinal deformity surgery at a single center was reviewed. Real-time data was collected on IONM alerts with >50% loss in signal. Patients with alerts were divided into 2 groups: unilateral changes (direct cord trauma), and bilateral MEP changes (cord perfusion deficits). Results: A total of 97 pediatric patients involving 71 females and 26 males with a mean age of 14.9 (11-18) years were included in this study. There were 39 alerts in 27 patients (27.8% overall incidence). All bilateral changes responded to a combination of transfusion, increasing blood pressure, and rod removal. Unilateral changes as a result of direct trauma, mainly during laminotomies for osteotomies, improved with removal of the causative agent. Following corrective actions in response to the alerts, all cases were completed as planned. Signal returned to near baseline in 20/27 patients at closure, with no new neurological deficits in this series. Conclusion: A high incidence of alerts occurred in this series of cases. Dividing IONM changes into perfusion-based vs direct trauma directed treatment to the offending cause, allowing for safe corrections of the deformities. Patients did not need to recover IONM signal to baseline to have a normal neurological examination.

Consequences of varicella zoster infection reflect a wide range of minor to serious complications involving the central nervous system. This is a case series with challenging presentations, imaging features and favorable outcome. For example, the cases presented with clinical features that resemble Brown Sequard Syndrome, transverse myelitis manner and multiple sclerosis and cognitive decline. We recommend adequate history taking, clinical examination and use of available investigation. Early treatment is likely to prevent any disabling neurological damage.

Incomplete spinal cord injury (SCI) often leads to impairments of sensorimotor functions and is clinically the most frequent type of SCI. Human Brown-Sequard syndrome is a common type of incomplete SCI caused by a lesion to one half of the spinal cord which results in paralysis and loss of proprioception on the same (or ipsilesional) side as the injury, and loss of pain and temperature sensation on the opposite (or contralesional) side. Adequate methodologies for producing a spinal cord lateral hemisection (HX) and assessing neurological impairments are essential to establish a reliable animal model of Brown-Sequard syndrome. Although lateral hemisection model plays a pivotal role in basic and translational research, standardized protocols for creating such a hemisection and assessing unilateralized function are lacking. The goal of this study is to describe step-by-step procedures to produce a rat spinal lateral HX at the 9th thoracic (T9) vertebral level. We, then, describe a combined behavior scale for HX (CBS-HX) that provides a simple and sensitive assessment of asymmetric neurological performance for unilateral SCI. The CBS-HX, ranging from 0 to 18, is composed of 4 individual assessments which include unilateral hindlimb stepping (UHS), coupling, contact placing, and grid walking. For CBS-HX, the ipsilateral and contralateral hindlimbs are assessed separately. We found that, after a T9 HX, the ipsilateral hindlimb showed impaired behavior function whereas the contralateral hindlimb showed substantial recovery. The CBS-HX effectively discriminated behavioral functions between ipsilateral and contralateral hindlimbs and detected temporal progression of recovery of the ipsilateral hindlimb. The CBS-HX components can be analyzed separately or in combination with other measures when needed. Although we only provided visual descriptions of the surgical procedures and behavioral assessments of a thoracic HX, the principle may be applied to other incomplete SCIs and at other levels of the injury.

Sulcal arteries perfuse the anterior two-thirds of the spinal cord, and spinal cord infarction as a result of sulcal artery occlusion is rare. Most reported cases are associated with vertebral artery dissection, and commonly involve the cervical spinal cord. A 74-year-old man presented with sudden onset weakness and numbness after a brief bout of abdominal pain. Further investigations concluded that this was sulcal artery syndrome. We report a case of sulcal artery syndrome affecting the thoracic spinal cord presenting as Brown–Sequard syndrome. Sulcal artery syndrome usually has good prognoses, unlike anterior spinal artery infarction.

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.

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.

Brown-Sequard syndrome is an uncommon complication of atlantoaxial arthrodesis. A 50-year-old female visited our emergency department after falling from a ladder. Radiologic evaluations revealed chronic C1-2 instability with acute spinal cord injury. The day after atlantoaxial fusion was performed, she developed left-sided motor weakness and the loss of right-sided pain and temperature sensation. Based on physical examination and radiologic findings, we diagnosed her as having Brown-Sequard syndrome. Spine surgeons performing this procedure should therefore consider Brown-Sequard syndrome if a patient displays signs of postoperative hemiplegia. Keywords: Os odontoideum, Atlantoaxial joint, Instability, Arthrodesis, Brown-Sequard syndrome, Cervical fixation, Complication

We report the case of a 45-year-old female who presented with acute left abdominal pain and subsequently developed a left partial Brown-Séquard syndrome. Spinal fluid, inflammatory and prothrombotic tests were unremarkable. Magnetic resonance showed a left intraforaminal disc prolapse at the T9–T10 level and a hyperintense lesion on T2-weighted images in the left postero-lateral cord at the T8–T9 level with restricted diffusion on DWI imaging. A diagnosis of spinal cord infarction due to compromise of the left T8 thoracic radicular artery was made. The patient was managed conservatively and at the 3 months follow-up, she was ambulant and able to walk small distances without a walker.

Stroke is generally considered to be the first preliminary diagnosis in patients presenting with acute hemiparesia in the emergency department. But rarely in unexpected spontaneous neurological pathologies that may lead to hemiparesis. The data from 8 non-traumatic patients who underwent surgical treatment for brown-sequard syndrome (BSS) were reviewed retrospectively. All patients were initially misdiagnosed with strokes. Two of the patients had spinal canal stenosis, two had spinal epidural hematomas, one had an ossified herniated disc and three had soft herniated discs. None of the patients complained of significant pain at the initial presentation. All of the patients had a mild sensory deficit that was initially unrecognized. The pain of the patients began to become evident after hospitalization and, patients transferred to neurosurgery department. Cervical spinal pathologies compressing the corticospinal tract in one-half of the cervical spinal canal may present with only hemiparesis, without neck and radicular pain. If it's too late, permanent neurological damage may become inevitable while it is a correctable pathology. Keywords: Brown-Sequard syndrome, Cervical cord, Herniated disc, Spinal epidural hematoma, Stroke

Cervical spontaneous intradural disc herniation (IDH) is an extremely rare condition. We describe a unique case of a patient presenting with a Brown-Sequard 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-Sequard syndrome (BSS) and discuss difficulties in preoperative diagnosis and treatment difficulties of intradural cervical disc. Notes and images review, and analysis of the relevant literature. A 45-year old female presented with acute Horner’s syndrome and Brown-Sequard 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. 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.

Introduction: Combination between SCIWORA and Brown-Sequard syndrome in a patient is a rare condition. In SCIWORA, there is usually a delay in neurologic deficits which can potentially lead to misdiagnosis. Therefore, the clinician should have a good understanding of the course of the disease to make a good diagnosis and treatment. Case report: Reporting a case of female 20 years old with chief complaint of severe neck pain and delayed limbs weakness. The mechanism of injury was fall with the head hit the ground in left lateral flexion position. The physical examination showed zero motor power of the right limbs and contralateral pain and temperature deficit 1 h after the injury. We diagnosed the patient with incomplete spinal cord injury at C4 level with associated Brown-Sequard syndrome. We gave soft collar neck for immobilization, medication with NSAID for analgetic and Methylprednisolon. We found dramatic improvement in 10 h after the injury with motor improvement from 0 to 5 and normal sensory function. The patient then was discharged with good functional outcome and with no sequelae. Conclusion: Incomplete cervical spinal cord injury without radiological abnormality that manifested as Brown-Sequard syndrome is a rare case and potentially confusing condition. Better understanding of the course of the disease may help the clinician to make a right diagnosis and plan for management. Keywords: SCIWORA, Brown-Sequard syndrome, Spinal cord injury

Infarction of the spinal cord is a rare entity in clinical practice. Limited literature exists on spinal cord stroke treatment, and the management is often symptomatic. The anterior spinal cord syndrome is the most common phenomenology, but here we present 2 nontraumatic spinal hemicord infarctions in elderly patients and discuss the clinical and radiological characteristics.

Brown-Séquard syndrome, while uncommon, is a neurological condition that classically results from the hemisection of the spinal cord as a result of a penetrating injury to the spinal cord. We present a reported case of blunt trauma causing a high-energy cervical burst fracture/dislocation with a significant cord signal change producing Brown-Séquard syndrome. In this case, the burst fracture at the level of C5 obtained from the motor vehicle accident led to the damage of the left-sided lateral spinal thalamic tract, descending lateral cortical spinal tracts, and ascending dorsal column. This is a unique case of blunt nonpenetrating trauma leading to a high-energy cervical burst fracture/dislocation causing significant cord signal change on T2-weighted magnetic resonance imaging (MRI). These physical changes produced symptoms of neurologic impairment commonly seen in those patients with Brown-Séquard syndrome.