Brown-Séquard syndrome: studying the causes, features of manifestation

Brown-Séquard syndrome (lateral hemisection of the spinal cord) is a disease of the spinal column and spinal cord, which involves damage to half the diameter of the spinal cord at one level or another of the spine.

The incidence of this pathology is about 1-3% of all spinal cord diseases. Men and women of different age categories suffer from this disease in equal proportions. It is not possible to completely cure the patient in all cases, but it is possible to achieve relief and reduce symptoms if you seek medical help in a timely manner.

Classification

Brown-Séquard syndrome is also called lateral hemisection of the spinal cord. This pathology is manifested by damage to certain areas of the brain. At risk are men and women of different age categories, regardless of professional activity or other factors. The disease is classified as follows:

• Classic look. All symptoms are fully consistent with the disease, which makes it possible to make a diagnosis with high accuracy.
• Inverted view. All signs characteristic of pathology appear on the opposite part of the body.
• Partial view. The symptoms do not correspond to the classical description; in some patients, signs are completely absent or appear in certain areas.

When dividing pathologies into types, the cause of the disease is also taken into account. Therefore, there are such types of syndrome as infectious, traumatic, tumor or hematological. Making a diagnosis is extremely important for choosing the right therapy.

Symptoms (signs)

Clinical picture.

In the acute period - phenomena of spinal shock (below the level of the lesion, complete flaccid paralysis and loss of all types of sensitivity are noted). In the future they develop: . Spastic paralysis (or paresis) and deep sensitivity disorder below the level of the lesion on the side of the same name. On the opposite (healthy) side, there is a loss of pain and temperature sensitivity to the level of conduction-type damage. Development of flaccid paresis and segmental loss of sensitivity at the level of damage. Ataxia, paresthesia, and radicular pain may occur.

Reasons for appearance

Neurology has long been studying the etiology of Brown-Séquard syndrome, and today we can say for sure that the disease does not occur independently. The main provoking factors are:

Ascending and descending tracts of the spinal cord

• Injury to the spine or spinal cord. This includes dislocations, bruises or fractures that a person has experienced during his life. This could be an injury, an accident, a fall from a height, or anything that led to the displacement of the vertebrae. Trauma is the most common cause that leads to the development of the syndrome.
• A tumor in the spinal cord or spine. Regardless of whether the formation is malignant or benign, it affects the general condition of the musculoskeletal system.
• Myelopathy of an infectious or inflammatory nature.
• Radiation sickness, damage to the spinal cord by radiation.
• Acute circulatory disorder of the spinal cord. This is often caused by a stroke or epidural hematoma.
• Spinal cord contusion.
• Abscesses that narrow the lumen of the spinal canal.
• Multiple sclerosis and other systemic diseases.

A constant negative impact on the spine, which impairs the flow of blood to one or another section, can also provoke the disease. In the later stages, it is incurable, so it is recommended to consult a specialist at the first signs of a violation of the normal physiology of the body.

The main symptoms observed in Brown-Séquard syndrome

Symptoms

Depending on the mechanism of occurrence, the pathology is manifested by a number of characteristic signs. Changes are noticeable not only on the affected part of the body, but also on the healthy one. Patients note the following changes in the body:

• Paralysis of the body below the level of the vertebral lesion.
• Loss of touch, temperature, or pain sensation.
• The patient is unable to feel his body weight, vibrations, or passive movements.
• The skin is bright red and cold to the touch.
• Trophic disorders of varying severity.

Pathology can be recognized by decreased sensitivity or limited motor activity on one side of the body. Some people have no symptoms, this is due to the individual characteristics of the body.

Affects the manifestation of the disease, localization zone:

• 1-2 cervical vertebrae. Paralysis of the arm, decreased sensitivity of the facial skin, loss of muscle sensitivity to irritants. A limb on the opposite side of the body begins to fail, and the normal sensation when touching the face, shoulders or neck disappears.
• 3-4 cervical vertebrae. Spastic paralysis on the injured side of the limb, dysfunction of the diaphragmatic muscles. On the part of the healthy part of the body, there is only a slight decrease in the susceptibility of the limbs to external stimuli.
• 5th cervical – 1st thoracic vertebra. Paralysis of the affected part, the patient loses the ability to move normally, and deep sensitivity disappears. On the second part of the body, the ability to superficially sense irritating factors disappears.
• Thoracic region from 2 to 7 vertebrae. The patient loses the ability to move the leg on the side of the ridge injury, and tendon reflexes disappear. Deep sensitivity disappears in the lower part of the body. The same applies to the skin of the leg, buttocks and lumbar region on the healthy side.
• Lumbar and sacrum. Motor function is lost, as well as deep sensitivity of the lower limb. Sensation disappears in the perineal area.

One of the important diagnostic indicators is the absence of dysfunction of the pelvic organs. Even if one side is paralyzed, the other ensures normal bladder emptying and defecation. Only in this case can the doctor suspect unilateral spinal cord injury.

1 What is Brown-Séquard syndrome: description of the disease

The disease is named after the discoverer who described the disease in detail - Charles Edouard Brown-Séquard, who lived from 1817 to 1894. Being a physiologist and neurologist by profession, Dr. Brown-Séquard already classified pathology as a symptom complex.

Brown-Séquard syndrome develops due to damage to one half of the spinal cord. On the affected part of the body, symptoms develop in the form of paralysis and sensory disturbances. Deep sensitivity is impaired, and the ability to perceive pain is often lost. Distinctive features of the pathology are loss of vibration and temperature sensitivity.

1.1 Reasons for appearance

Separately, such a symptom complex is rare. Usually this is a consequence of some other inflammatory, traumatic or infectious disease.

Main reasons:

1. Traumatic injuries to the spinal cord (as a result of an accident, fall, spinal injuries).
2. Stab or cut wounds of the spine.
3. The presence of malignant neoplasms in bone tissue (sarcoma) or in nerve tissue and its membranes (usually meningioma, neuroma or glioma).
4. Abscesses (ulcers) or epidural hematomas (bleeds) in the spine, leading to compression of the spinal cord.
5. Severe damage to the spinal vessels (ischemia, hematoma due to trauma, spinal angioma).
6. Myelopathy due to radiation therapy.
7. Multiple sclerosis.

Causes at the level of pathogenesis (reasons for the development of the symptoms themselves):

• the development of conduction disorders is always below the level of the lesion;
• development of segmental and radicular disorders (only at the level of the lesion).

1.2 Is there a cure for Brown-Séquard syndrome?

The possibility of treatment depends on the causes that led to the development of the disease. If it is malignant neoplasms or multiple sclerosis, the chances of successful treatment are low.

If the cause is an abscess or epidural hematoma, drainage is usually sufficient to cure it.

With mechanical compression of the spinal cord, such factors are surgically eliminated and a partial or complete cure occurs. But if the syndrome lasts too long, there is a high risk of residual effects after it is cured.

1.3 Examination of a patient with Brown-Séquard syndrome (video)

1.4 Why is Brown-Séquard syndrome dangerous?

Brown-Séquard syndrome is an extremely severe pathology, fraught not only with disability, but also with death of the patient. Lethal complications can be observed already in the first day from the moment of compression (squeezing) of the spinal cord.

The most severe complications:

• severe pain in the spine and head (may resemble cluster headaches);
• hemorrhage (stroke) in the spinal cord;
• severe dysfunction of organs located in the pelvis (incontinence of feces or urine, disappearance of the urge to urinate and defecate, persistent constipation, development of impotence);
• complete rupture (similar to a rupture of the heart muscle) of the spinal cord;
• spinal shock.

The disease can lead to disability or death

Decompression of the spinal cord cannot be delayed - death can occur at any time, but in addition to death, there are quite serious complications. The prognosis is especially serious for older people and children under 8 years of age.

Diagnostic procedures

When the first signs of illness appear, you should immediately consult a doctor. He conducts a visual examination, studies the patient’s chart, prescribes tests and x-rays. A comprehensive examination allows you to verify the presence of pathology. The main methods are:

• Visual inspection. It allows you to determine a person’s ability to move normally and move their limbs. Without restrictions, it is impossible to suspect the development of pathology.
• Palpation. The doctor determines the superficial sensitivity of the skin, the patient’s reaction to passive movements in the joints of the limbs.
• Neurological examination. It is important to conduct tests for the presence of tendon reflexes, the presence of pain, temperature or tact sensitivity.
• X-ray. The image shows pathological changes in the vertebrae, injuries, and displacement of intervertebral discs. Suitable for early detection of disease.
• CT scan. One of the most informative techniques that allows you to study the condition of the vertebrae, muscle tissue and cartilage in a segmental section.
• Magnetic resonance imaging. The results obtained allow the doctor to thoroughly examine the general condition of the spine, determine the degree of damage to the ridge, as well as how much the spinal cord was affected.

It is important to clarify how much time has passed since the first symptoms appeared. To determine paralysis and evaluate muscle tone, a neurological hammer or a special needle is used. To clarify a diagnosis such as “Brown-Séquard syndrome”, a study of deep and superficial sensitivity is required; various tests are used for this.

The main method of treatment is surgery

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Diagnosis of the disorder

When visiting a medical facility, specialists first collect the patient’s medical history. They are interested in how long ago the symptoms began to manifest themselves and with what intensity they develop.

It is also important to check the presence of various reflexes and sensitivity of all limbs. In order for the diagnosis to be made correctly, with full confidence and confirmation from the doctor, the patient will need to undergo a special course of medical examinations, which will allow them to establish a clear picture of the disease and prescribe competent treatment.

The examination includes:

• X-ray examination (makes it possible to detect spinal damage in the early stages);
• Computed tomography allows you to identify problems not only in bone tissue, but also in muscles, nerve endings and blood vessels;
• MRI (magnetic resonance imaging) today is considered the most informative, as it combines a lot of additional information that cannot be obtained using previously described methods.

Treatment of the disease

For comprehensive treatment of the syndrome, it is important to establish the cause of its development. If it is a hematoma or tumor, surgery is prescribed to eliminate it. It is important to restore the integrity of the spinal column, as well as eliminate the possibility of compression or damage to the spinal cord and nerve endings. Treatment is carried out only surgically, and the earlier the manipulation is prescribed, the lower the risk of complications.

The main goal of surgery is to eliminate compression and all factors affecting the brain, nerve endings, and blood vessels. The type of operation is selected individually, based on the cause of the disease. After the procedure, a rehabilitation course is selected for the patient. Typically it includes:

• Taking medications - these can be vitamin complexes, drugs that improve blood circulation in the brain tissue, as well as tablets to prevent thrombosis.
• Therapeutic exercise – performing special exercises allows you to get rid of pain, normalize blood circulation, improve the elasticity and mobility of the spine.
• Physiotherapy can be various techniques that improve metabolic processes in tissues through the effects of current, laser or magnetic fields. They are carried out using special equipment and only under the supervision of specialists. The most popular manipulations are ultrasound, electrophoresis, UHF therapy, paraffin baths and magnetic therapy.
• Massage – by influencing soft tissues, it is possible to improve blood circulation in the affected area, normalize the movement of biological fluids, and speed up metabolism. The session should only be performed by an experienced, qualified specialist so as not to harm the patient.
• Diets – Proper nutrition is an important part of restoring cartilage health. The menu is developed individually, taking into account individual characteristics and the presence of chronic pathologies.

The pathology is dangerous due to its complications, therefore it is strictly forbidden to self-medicate, change the dosage of drugs, or the number of approaches when performing physical therapy exercises. Only strict adherence to all recommendations allows you to maintain normal motor activity and slow down the progression of pathology.

Effective patient rehabilitation

Patients with this symptom complex require a certain amount of time to recover after undergoing surgery.

During the rehabilitation period it is shown:

• performing special exercises;
• undergoing physiotherapeutic procedures;
• following a well-planned diet;
• calmness and avoidance of stress.

An important role is played by physical therapy exercises. Its effectiveness cannot be underestimated.

Thanks to exercise therapy:

1. Metabolic processes are being improved.
2. Blood microcirculation is activated.
3. The muscle frame is strengthened.

The doctor determines individually how many exercises should be performed and in what sequence. To achieve a speedy recovery, the patient requires physical therapy.

Rehabilitation includes:

• paraffin applications;
• heating with ozokerite;
• electrophoresis using potassium iodide;
• diadynamic currents;
• ultrasound;
• UHF therapy.

In the long term, patients often experience partial or complete neurological recovery.

Possible forecast

Doctors cannot give accurate predictions when making such a diagnosis. It is possible to prevent the progression of the disease only if all medical recommendations are strictly followed. In this case, the prognosis is almost always favorable. Approximately 90% of patients retain the ability to move independently and control the functioning of the pelvic organs. Untimely treatment of the pathology threatens the patient with the following pathological conditions:

• dysfunction of the genitourinary organs;
• hematomyelia;
• intense pain in the back and head;
• hemorrhages in the spinal cord;
• chronic migraines;
• spinal cord rupture;
• spinal shock.

In addition, the patient may have problems with potency, reproductive function, urinary or fecal incontinence, and chronic constipation. When an arteriovenous aneurysm ruptures in the spine, acute unbearable pain is observed that cannot be relieved by pills.

Diagnostics

After the patient goes to the hospital, the doctor will take an anamnesis and check the reflexes and sensitivity of the limbs. A specialist will be able to make an accurate diagnosis only after examination data.

Instrumental diagnostic methods include:

• X-ray of the spine - allows you to identify damage to the spine;
• – makes it possible to identify changes not only in bone tissue, but also in blood vessels, muscles and nerve endings;
• MRI is the most informative method for studying damage to the spinal column and spinal cord.

Preventive actions

The pathology is dangerous and can lead to loss of mobility and disability. Therefore, many people think about how to protect themselves from it. There are no preventive measures as such, but there are certain actions that can minimize the risk of developing the syndrome:

• Be careful while driving to avoid the possibility of an accident.
• Follow safety rules when working at heights or on dangerous equipment.
• Contact a doctor for a preventive examination or when the first signs of illness appear.
• Watch your posture, keep your back straight when working at the computer or staying in a static position.

If damage or injury cannot be avoided, it is important to treat it in strict compliance with all doctor's recommendations. If conditions worsen, you should immediately seek medical help to avoid complications or the development of chronic pathologies. This is also a reliable preventative measure.

Brown-Séquard syndrome is considered a dangerous lesion, which is characterized by the appearance of a number of neurological disorders. The patient rarely manages to fully recover, but with timely surgical intervention, there is a high chance of maintaining a normal quality of life.