IMAGES IN C LINICA L MED IC INE

Images in Clinical Medicine

BrownSquard Syndrome
A 21-year-old man presented with a stab wound of the left side of the neck (Panel A). Neurologic examination revealed right-sided Horners syndrome, right hemiplegia, and complete loss of discriminatory, proprioceptive, and vibratory sensation below the level of C5 on the right side. On the left side, the patient had a loss of pain and temperature sensation below the level of C7, as well as a loss of proprioception in the leg. The findings were diagnostic of BrownSquard syndrome, with the additional finding of a loss of proprioception on the left. The patient was thought to have sustained a hemisection of the right side of the spinal cord at C4 and injury of the dorsal column of the left side of the spinal cord. Horners syndrome was attributed to injury of the right intermediolateral cell column. Magnetic resonance imaging (MRI), performed to rule out an epidural hematoma, confirmed the diagnosis. A right-sided parasagittal T2-weighted cervical MRI shows spinal cord hemisection at C4 (arrow in Panel B). An axial T2-weighted MRI through the level of the lesion (Panel C) shows increased signal intensity indicative of edema in the swollen right side of the spinal cord (large arrow), as well as in the dorsal aspect of the left side of the spinal cord (small arrow). The linear area of decreased signal intensity extending from the left dorsal to the right ventral aspect of the spinal cord (small arrowhead) represents hemorrhage in the spinal cord along the trajectory of the knife. The large arrowhead points to the C4 vertebral body. Three months after his injury, the patient had only minor sensory changes and weakness, had normal bowel and bladder function, walked with minimal assistance, and had returned to independent living. ANDREW D. FIRLIK, M.D. WILLIAM C. WELCH, M.D.
1999, Massachusetts Medical Society.

University of Pittsburgh Medical Center Pittsburgh, PA 15213-2582 Vol ume 340 Numb e r 4

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The New England Journal of Medicine Downloaded from nejm.org on November 9, 2012. For personal use only. No other uses without permission. Copyright 1999 Massachusetts Medical Society. All rights reserved.