Brown-Séquard syndrome (Brown-Séquard's paralysis, hemiparaplegic syndrome) is caused by damage to one half of the spinal cord, resulting in paralysis and loss of proprioception on the same (or ipsilateral) side as the injury or lesion, and loss of pain and temperature sensation on the opposite (or contralateral) side as the lesion.
Brown-Séquard syndrome may be caused by injury to the spinal cord resulting from a spinal cord tumour, trauma [such as a fall or injury from gunshot or puncture to the cervical or thoracic spine], ischemia (obstruction of a blood vessel), or infectious or inflammatory diseases such as tuberculosis, or multiple sclerosis
The hemisection of the cord results in a lesion of each of the three main neural systems:
the principal upper motor neuron pathway of the corticospinal tract
one or both dorsal columns
the spinothalamic tract
As a result of the injury to these three main brain pathways the patient will present with three lesions:
The corticospinal lesion produces spastic paralysis on the same side of the body below the level of the lesion (due to loss of moderation by the UMN).
At the level of the lesion, there will be flaccid paralysis of the muscles supplied by the nerve of that level (since lower motor neurons are affected at the level of the lesion).
The lesion to fasciculus gracilis or fasciculus cuneatus results in ipsilateral loss of vibration and proprioception (position sense) as well as loss of all sensation of fine touch.
The loss of the spinothalamic tract leads to pain and temperature sensation being lost from the contralateral side beginning one or two segments below the lesion
Magnetic resonance imaging (MRI) is the imaging of choice in spinal cord lesions.
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