Damage to one-half of the spinal cord results in the neurological disease Brown Sequard syndrome (BSS). This rare condition causes less than 2% of spinal nerve injuries. It is also one of the incomplete Spinal Cord Syndromes. Charles-Édouard Brown-Séquard, a French neurologist who first described the disease in 1850, is honored by having the syndrome bear his name.
1. Charles-Édouard Brown-Séquard
Physiologist and neurologist Charles-Édouard Brown-Séquard (1817–1894) made significant contributions to our knowledge of the nervous system and endocrine glands.
In his studies of the physiology of the spinal cord, Brown-Séquard established that distinct regions of the cord are in charge of various functions. He also made significant contributions to our knowledge of the endocrine system by demonstrating the critical function of the adrenal glands in blood pressure control.
The neurological condition known as “Brown-Séquard syndrome,” which is brought on by harm to one side of the spinal cord, is one of Brown-most Sequard’s well-known findings. On one side of the body, there is a loss of sensation and movement; on the other, there is a heightened sensitivity to pain and temperature.
Along with his scientific contributions, Brown-Séquard was a talented medical educator and author. “Lectures on the Diagnosis and Treatment of Functional Nervous Affections” and “Experimental and Clinical Researches on the Physiology and Pathology of the Spinal Cord” were among his writings.
2. Brown Sequard Syndrome
The brown-Séquard syndrome is brought on by harm to one-half of the spinal cord (incomplete spinal cord injury), and it appears as a recognizable pattern of symptoms reflecting the functional anatomy of the spinal cord.
A loss of motor function on the affected side of the body (ipsilateral) and a loss of sensory function on the affected side of the body (contralateral) are common outcomes of damage to one-half of the spinal cord.
The reason for this is that while the nerve fibers that convey sensory information from the body cross over to the opposite side of the spinal cord before reaching the brain, the nerve fibers that control motor function start on the same side of the spinal cord as the muscles they control.
3. Spinal Cord
The spinal cord runs through the bones from the base of the brain to create an uninterrupted, tubular network of nerve tissue. It is an essential central nervous system (CNS) component and plays a critical function in brain-to-body communication.
3.1 Components of Spinal Cord
Millions of neurons, specialized cells that send information throughout the neural system, make up the spinal cord. Along the length of the spinal cord, these neurons are arranged into various regions, each with a distinct purpose.
Additionally, layers of bone, ligaments and cerebrospinal fluid that act as a cushion and shield the spinal cord from harm surround it.
3.2 Spinal Cord Injury
Inadequate information transfer between the brain and the body can have severe repercussions if the spinal cord is damaged. Trauma, like a vehicle accident or a fall, as well as illnesses like multiple sclerosis or spinal cord tumors, can cause spinal cord injuries.
The location and seriousness of the injury determine the scope of the harm and the symptoms that follow.
3.3 Idiopathic Spinal Cord Herniation
In the rare idiopathic spinal cord herniation(ISCH) illness, the spinal cord pushes through a hole in the dura mater, the membrane surrounding it, compressing nearby nerves. ISCH is regarded as “idiopathic,” meaning it happens spontaneously or without a known cause because the reason is unknown.
ISCH may result in Brown-Sequard syndrome if it compresses the spinal nerve on one side, impairing function on one side of the body and sensory function on the other.
The location and extent of the herniation will determine the particular Brown-Séquard syndrome symptoms that accompany ISCH. Therefore, Brown-Séquard syndrome is said to be a rare neurological condition.
4. What Causes Brown Sequard Syndrome?
The brown-Séquard syndrome has several prevalent causes, including:
4.1 Diseases of Degeneration
Some degenerative conditions, such as multiple sclerosis or syringomyelia(a condition in which cavities filled with fluid develop within the spinal cord), can harm one side of the spinal cord and lead to Brown-Séquard syndrome.
Brown-Séquard syndrome can be brought on by infections like tuberculosis or abscesses that harm the spinal cord.
4.3 Traumatic Injury
A traumatic injury that damages one-half of the spinal nerve can cause Brown-Sequard Syndrome. This may result from a car mishap, a slip, and fall, or a wound that penetrates the skin, like a gunshot wound.
Brown Sequard Syndrome can be brought on by tumors that develop inside or close to the spinal cord and harm one side of the spine.
4.5 Spinal Cord Herniation
Idiopathic spinal cord herniation (ISCH) which can compress one-half of the spinal cord, can cause brown-Séquard syndrome, as was previously mentioned.
5. Symptoms of Brown Sequard Syndrome
The precise symptoms of Brown Sequard Syndrome vary depending on where the damage is located along the spinal cord. The nature of the symptoms generally increases with the degree of harm. Typical symptoms of Brown Sequard Syndrome include the following:
A person with paralysis loses muscle function or movement in a portion of their body. Any portion of the body, including the arms, legs, torso, and face, can experience this loss of function, which can be either partial or complete paralysis.
5.2 Loss of Pain and Temperature Sensation
Lack of Sensitivity to Both Pain and Temperature Other sensory abnormalities, such as the loss of touch, pressure, and vibration sense, may follow the loss of pain and temperature sensation after a spinal cord injury, depending on the location of the damage and its severity.
5.3 Loss of Bowel and Bladder Control
An individual who has lost voluntary control over their bowel and bladder motions is said to have lost bowel and bladder control. It can be a sign of several illnesses, including neurological diseases like Brown-Séquard syndrome.
5.4 Sexual Dysfunction
A common sexual dysfunction that can occur in this spinal cord injury is erectile dysfunction, which is caused by the inability to obtain or sustain an erection. Erectile dysfunction can result from spinal cord injury in Brown Sequard Syndrome because the nerves that regulate blood supply to the penis are affected.
Additionally, it may be challenging to experience orgasm due to reduced sensitivity in the genital region.
Spasticity is most common in Brown Sequard Syndrome on the side of the body that has lost sensory and motor ability. This happens because a spinal cord injury can produce an overactive reflex response in the affected muscles leading to muscle weakness.
When there is no feedback from the affected side of the body, the muscles become hyperexcitable, resulting in involuntary contractions and spasms.
6. Diagnosis and Treatment
6.1 Differential Diagnosis
To clear out other possible causes, a differential diagnosis may be required. Brown Sequard syndrome has several alternative diagnoses, including multiple sclerosis, stroke, tumor or incomplete spinal cord lesion, and transverse myelitis.
6.2.1 Medical History
A healthcare provider will typically begin by taking a thorough medical history, which includes inquiries about symptoms, the onset of symptoms, and any recent injuries or illnesses.
6.2.2 Physical Examination
A physical examination can aid in determining the position and extent of spinal cord damage. Typically, the healthcare practitioner will assess motor function, sensation, and reflexes on both sides of the body. In Brown Sequard Syndrome, one side of the body may experience weakness or paralysis and a loss of sensation on the opposing side.
6.2.3 Imaging Tests
Magnetic resonance imaging (MRI) or computed tomography (CT) scans can help determine the location and degree of spinal cord damage. These tests may also assist in eliminating other possible reasons of the symptoms being experienced.
6.2.4 Electromyography (EMG)
Electromyography is a diagnostic test that can help assess muscle and nerve function. In Brown Sequard Syndrome, EMG may aid in the identification of muscular weakness or spasticity on one side of the body.
Brown-Séquard syndrome treatment usually centers on symptom management as well as addressing the underlying cause of spinal cord damage. Among the treatment choices available are:
Medications may be given to treat symptoms such as pain, spasticity, and bladder and bowel dysfunction. Muscle relaxants, for example, may be used to treat spasticity, and pain medicines may be used to treat neuropathic pain.
6.3.2 Physical and Occupational Therapy
Physical therapy can help you increase your strength, flexibility, and range of motion. Patients diagnosed with Brown Sequard Syndrome can develop a specialized exercise routine in collaboration with a physical therapist.
Occupational therapy can help people with Brown Sequard Syndrome learn new methods to do everyday tasks like dressing and cooking to compensate for weakness or loss of sensation.
In some instances, such as removing a tumor or repairing a herniated disc, surgery may be required to address the underlying cause of the spinal cord damage.
6.3.3 Assistive Devices
Assistive Devices such as braces or wheelchairs may be required to help people with Brown Sequard Syndrome keep their mobility and independence.
6.3.4 Management of Bladder-digestive Function and Blood Tests
Medication, catheterization, or bowel training may be used to manage bladder and bowel function.
Blood tests can help clear out other possible causes of symptoms, such as infections or autoimmune disorders.
The ASIA (American Spinal Injury Association) is dedicated to improving clinical care, education, and research for spinal cord injuries (SCI). People with Brown Sequard Syndrome or other types of SCI can gain from the tools and assistance groups like ASIA offer.
To manage their symptoms and improve their quality of life, people with SCI must work closely with their medical professionals and have access to comprehensive treatment.
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