SPINAL CORD HEMISECTION

SPECIALIST REGISTRAR
MEDICAL UNIT MMMTH
FCPS MEDICINE
MRCP UK
SCENERIO
 A 23-year-old male is brought to the emergency
department after being stabbed in the back. On primary
survey, his GCS is 15 with his airway, breathing, and
circulation intact. Secondary survey is notable for a stab
wound to the midline of his lumbar spine at the L1 level. His
temperature is 37.0°C , pulse is 110/min, R.R 11/min, 
blood pressure is 110/74 mmHg, and O2 saturation is 96%
on room air.
 Neurologic examination is notable for ipsilateral loss of
motor function, vibration, and proprioception below the L1
level, with contralateral loss of pain and 
temperature sensation beginning approximately at the L3-
L4 level. Most likely diagnosis? 
BACK TO BASICS FIRST
ASCENDING TRACTS
DESCENDING TRACTS
Brown-Séquard Syndrome

 A rare neurological condition characterized

by a lesion in the spinal cord which results in:

- paralysis and loss of proprioception on the

same (ipsilateral) side as the injury or lesion
-ipsilateral UMN signs

- loss of pain and temperature sensation on the

opposite (contralateral side of the lesion)
Brown-Séquard Syndrome-causes
-Trauma
-Neoplasia
-Multiple sclerosis (MS)
-Degenerative (disc herniation or cervical
spondylosis)
-Cysts and cystic diseases
-Idiopathic spinal cord herniation
-Haemorrhage/ ischaemia
-Infection
How would you investigate?
Thank you