Brown Sequard

Syndrome
Hemisection or hemilesion of the spinal cord.
Uncommon case.
Clinical manifestation:
Loss of motoric function ipsilaterally (corticospinal
tract) UMN type
Proprioceptive disturbance ipsilaterally (posterior
column)
Loss of pain & temperature sensation
(exteroceptive function) contralaterally.
 Etiology
Spinal cord tumor
Trauma : penetrating injury (gun shot, etc)
Ischemic
Hemorrhage
Infection or inflammation: tuberculosis,
multiple sclerosis
Example: lesion in the left side

Spastic paralysis
Flaccid paralysis
All sensoric function is disturbed
Proprioceptive dysfunction
Loss of pain & temperature sensation
SYRINGOMYELIA
 Syringomyelia
A chronic progressive degenerative disorder
of the spinal cord, caused by gliosis & tube-
like (syrinx) cavity in the central part of the
spinal cord (medulla).
Male > female, 25 – 40 years old
Syrinx is usually in the lower cervical & upper
thoracal segment (can extend upward to the
medulla oblongata or downward into the
lumbar segments.
Etiology
Based on theory:
Old theory :
1. Central canalis is not completely closed 
leaving cavity & secondary gliosis
2. In the closing process, rest of spongioblast
in the central canal form glial tissue 
forming a cavity
3. Chronic Glioma  cystic degeneration
Etiology
New theory:
1. Obstruction of outlet of the fourth ventricle.
Found in: Arnold Chiary malformation
(protrution of cerebellar tonsil  foramen
magnum) or Dandy Walker malformation 
no For.magendi & for. Luschka.
2. Artery pulsation  pulsation in the fourth
ventricle (Gardner’s theory)

Both process cause formation of cavity in the

spinal cord.
Clinical manifestation

Dissociated sensory loss (pain & temp.

is disturbed, BUT proprioceptive is
intact).
If Corticospinal tract is afected 
spastic paraparesis (UMN type)
destruction of motoric neurons in the
anterior horn  paresis LMN type
autonomic tracts involeved:
micturation & defecation disturbance
 spastic bladder.
SPECIAL EXAMINATION

LP : ~ Normal pressure
~ Increased protein level
~ Queckenstedt is negative if blocking
pesist
 Radiologic Examination
Abnormalities of vertebral column  X-ray 
abnormal development process.
Klippel feil Syndrom (Fusion)
Platybasia
Basilar invagination
Spina bifida
Cervical Rib