Spinal Cord Hemisection


Spinal Cord Hemisection, Brown-Sequard Syndrome, Hemicord Syndrome, Hemiparaplegic Syndrome

  • Epidemiology
  1. Uncommon Spinal Injury, accounting for only 4% of spinal cord injuries per year in the U.S.
  • Pathophysiology
  1. Hemisection of the spinal cord most affects the posterior cord
  2. Unilateral (hemi-cord) cord injury affecting the dorsal columns, Corticospinal tract and Spinothalamic Tract
  3. Spinothalamic Tract crosses to the contralateral side (giving the crossed effects)
  4. Images
    1. CordSyndrome.jpg
  • Causes
  1. Penetrating Trauma (most common)
  2. Vertebral Fracture with lateral cord compression
  3. Blunt Spinal Cord Injury
  4. Disc Herniation
  5. Epidural Hematoma
  6. Decompression Sickness complication
  • Signs
  1. Ipsilateral motor weakness
  2. Ipsilateral proprioception and vibratory Sensation loss below the lesion
  3. Contralateral pain and TemperatureSensation loss starting two levels below the lesion
  • Associated Conditions
  • Management
  1. Consult neurosurgery for possible decompression surgery
  2. Avoid Corticosteroids (not recommended)
  • Prognosis
  1. Brown-Sequard Syndrome has an overall good prognosis
  2. Motor function is recovered in more than half of cases
  • References
  1. Decker in Chorley and Bachur (2014) Overview of Cervical Spinal Cord Injuries..., UpToDate, Wolters-Kluwer
  2. Rodriguez, Winger, Poulo and Glunk (2023) Crit Dec Emerg Med 37(3): 23-9
  3. Wagner (1997) Emerg Med Clin North Am 15:699-711 [PubMed]