Makindo Medical Notes

🧾 Introduction

• ⚡ Rare neurological syndrome caused by a lesion affecting one half of the spinal cord (hemi-cord).
• 🧠 Produces a characteristic pattern: motor + dorsal column loss ipsilateral, spinothalamic loss contralateral.

ℹ️ About

• 🦠 Infection: e.g. Tuberculosis, syphilis
• 🔥 Inflammatory: Multiple sclerosis plaques, transverse myelitis
• 🎗️ Spinal tumours
• 🤕 Trauma: stab wounds, gunshot injuries, fracture-dislocation
• 💿 Disc herniation (rare unilateral cord compression)

🧬 Anatomy

• 🎯 Most often seen in the thoracic spine
• 📌 Pathophysiology reflects interruption of: – Corticospinal tract (motor, ipsilateral weakness) – Dorsal columns (ipsilateral vibration, proprioception) – Spinothalamic tract (contralateral pain & temperature)

🧪 Aetiology

• 📍 Unilateral spinal cord lesion (hemi-section or compression)
• 📊 Commonest level = thoracic region

🩺 Clinical Features

• 💪 Ipsilateral weakness/paralysis (UMN pattern: spasticity, hyperreflexia)
• 🦶 Ipsilateral loss of vibration, fine touch, proprioception
• 🔥 Contralateral loss of pain & temperature (spinothalamic fibres cross 1–2 levels above entry)
• 😮 Lesion above T1 → ipsilateral Horner’s syndrome (ptosis, miosis, anhidrosis)
• 🩹 Trauma cases often have associated injuries (fractures, vascular injury)

🔎 Investigations

• 🧪 Bloods: FBC, U&E, CRP (infection, systemic causes)
• 🖥️ MRI spine = gold standard for localisation & cause
• 🖼️ CT spine if bony injury suspected
• 💉 LP + CSF: if infection/inflammatory suspected (TB, MS)
• ⚡ Nerve conduction studies/EMG for chronic or peripheral overlap

🧫 Pathology

• 🔍 Classic “hemisection” syndrome rarely complete in practice—often partial with mixed findings.

💊 Management

• 🫀 Initial trauma care: ABC, IV fluids, spinal immobilisation
• ♿ Rehabilitation: physiotherapy, occupational therapy, long-term neurorehabilitation
• 🚽 Bladder & bowel management; prevent pressure sores
• 🎯 Treat underlying cause: – Surgery for tumour, disc herniation, abscess – Antibiotics/antituberculous therapy if infective – Steroids/DMARDs if inflammatory (e.g. MS)
• 📈 Prognosis: generally better than complete cord injury; ~75% regain functional ambulation if managed appropriately

📌 Exam Pearl: – Ipsilateral motor & proprioception loss + contralateral pain/temp loss = classic triad. – Always think of trauma (stab wounds) as the classic cause in exams, but in practice MS and TB are also common.

📚 References

• StatPearls: Brown-Séquard Syndrome
• ScienceDirect: Brown-Séquard Overview