Brown-Séquard Syndrome
This patient's presentation of ipsilateral motor loss (inability to move left leg) combined with contralateral sensory loss (inability to sense deep painful stimuli in right leg) after traumatic injury is classic for Brown-Séquard syndrome.
Clinical Presentation
The hallmark features of Brown-Séquard syndrome result from hemisection of the spinal cord and include 1, 2:
- Ipsilateral motor paralysis below the level of injury (left leg paralysis in this case)
- Contralateral loss of pain and temperature sensation beginning 2-3 levels below the injury (right leg in this case)
- Ipsilateral loss of proprioception and vibratory sensation (though not mentioned in this case)
Mechanism in Traumatic Injury
In this farmer crushed by a tractor, the severe back pain indicates vertebral column injury with likely spinal cord compression 2, 3. Brown-Séquard syndrome is most commonly seen with:
- Penetrating spinal trauma (stab wounds, gunshot wounds) 3
- Blunt trauma causing vertebral fractures with cord compression 2
- Less commonly: disc herniation, tumors, or inflammatory conditions 1, 4, 5
The traumatic mechanism in this case makes Brown-Séquard syndrome the most likely diagnosis given the characteristic crossed motor-sensory findings 3.
Why Not the Other Syndromes
Anterior cord syndrome would present with bilateral motor loss and bilateral loss of pain/temperature sensation while preserving proprioception and vibratory sense—not the unilateral pattern seen here.
Central cord syndrome typically affects the upper extremities more than lower extremities (inverted pattern from this case) and occurs predominantly in elderly patients with cervical hyperextension injuries.
Posterior cord syndrome would cause bilateral loss of proprioception and vibratory sensation while preserving motor function and pain sensation—opposite of this presentation.
Prognosis and Management
Brown-Séquard syndrome carries the best prognosis of all incomplete spinal cord injury patterns 2. Multiple case reports demonstrate near-complete or complete recovery with early surgical decompression when indicated 1, 2, 4. This patient requires urgent MRI to define the injury and determine need for surgical decompression 4.