Brown-Séquard Syndrome
This patient has Brown-Séquard syndrome, characterized by ipsilateral motor weakness and loss of proprioception/vibration sense with contralateral loss of pain and temperature sensation following a penetrating spinal cord injury. 1, 2, 3
Classic Clinical Features Present in This Case
The diagnosis is confirmed by the following hallmark findings:
- Ipsilateral motor deficits: Right leg weakness (3/5 power) with brisk reflexes and upgoing plantar response indicating upper motor neuron involvement 1, 2
- Ipsilateral dorsal column loss: Absent vibration and joint position sense in the right leg 1, 3
- Contralateral spinothalamic tract loss: Loss of pain and temperature sensation on the left side below T10, while light touch (which travels in both dorsal columns and spinothalamic tracts) remains preserved 1, 2
- Preserved anal tone: Rules out complete spinal cord transection and cauda equina syndrome 4
Why Other Diagnoses Are Excluded
Anterior spinal artery syndrome would cause bilateral motor weakness with bilateral loss of pain/temperature sensation while preserving dorsal column function (proprioception and vibration)—the opposite of what this patient demonstrates. 1
Central cord syndrome typically presents with greater upper extremity weakness than lower extremity weakness, often with sacral sparing, and occurs most commonly in hyperextension injuries in patients with cervical spondylosis—not consistent with this presentation. 4
Cauda equina syndrome presents with urinary retention (90% sensitivity), bilateral lower extremity weakness, saddle anesthesia, and loss of anal tone—none of which are present in this patient. 4
Complete spinal cord transection would cause bilateral motor and sensory loss below the level of injury with loss of anal tone, not the characteristic hemicord pattern seen here. 2, 3
Mechanism and Prognosis
Brown-Séquard syndrome results from hemisection of the spinal cord, most commonly from penetrating trauma such as stab wounds or gunshot injuries, though it can also occur from disc herniation, tumors, or inflammation. 1, 5, 2
This syndrome carries the best prognosis of all incomplete spinal cord injury patterns, with most patients achieving good to near-complete neurologic recovery, particularly when managed with early surgical decompression when indicated and intensive rehabilitation. 2, 6
The penetrating injury from the metal fragment in this patient's back directly caused the hemisection at the thoracic level, explaining the T10 sensory level on the contralateral side. 2, 3