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1.
Nursing ; 51(4): 62-66, 2021 Apr 01.
Artículo en Inglés | MEDLINE | ID: mdl-33759868

RESUMEN

ABSTRACT: Incomplete spinal cord injury is challenging to diagnose and treat. This overview of Brown-Séquard syndrome outlines key assessment and nursing considerations important to enhancing recovery outcomes.


Asunto(s)
Síndrome de Brown-Séquard/enfermería , Síndrome de Brown-Séquard/fisiopatología , Síndrome de Brown-Séquard/rehabilitación , Humanos , Evaluación en Enfermería , Diagnóstico de Enfermería , Resultado del Tratamiento
2.
Rev. neurol. (Ed. impr.) ; 71(1): 26-30, 1 jul., 2020. ilus
Artículo en Español | IBECS | ID: ibc-195441

RESUMEN

INTRODUCCIÓN: La hernia medular idiopática es una patología infrecuente que cursa clínicamente con una mielopatía progresiva, la mayoría de las ocasiones en forma de síndrome de Brown-Séquard. Su base anatómica es un defecto dural por el que se incarcera progresivamente una porción del cordón medular anterior. La resonancia magnética y la mielotomografía demuestran un acodamiento medular en «tienda de campaña» hacia la cara anterior del estuche dural, a nivel dorsal medio fundamentalmente. Caso clínico. Varón de 37 años, diagnosticado de hernia medular idiopática e intervenido quirúrgicamente mediante una técnica propia; se demuestra su correlación neurorradiológica, anatomoquirúrgica y evolutiva. CONCLUSIÓN: El tratamiento debe ser individualizado, pues no existe una técnica quirúrgica universalmente establecida


INTRODUCTION: Idiopathic medullary herniation is an infrequent disease, which shows up in clinical form as a progressive mielopathy, most commonly known as the Brown-Séquard syndrome. Its anatomical base is a dural defect where a portion of anterior spinal cord gets progressively incarcerated. The MRI and myelo-CT scan show a bending of the spinal cord in the form of a «bell tent» towards the anterior dural sheath at the mid-dorsal portion mainly. CASE REPORT: A 37 year old male, who was diagnosed of idiopathic medullary herniation and surgically treated by our own developed technique, reporting its neuroradiological, anatomo-surgical and clinical correlation. CONCLUSION. Treatment should be individualized, as no standard surgical technique has been established up to the present


Asunto(s)
Humanos , Masculino , Adulto , Síndrome de Brown-Séquard/etiología , Progresión de la Enfermedad , Hernia , Enfermedades de la Médula Espinal/diagnóstico por imagen , Herniorrafia/métodos , Enfermedades de la Médula Espinal/cirugía , Síndrome de Brown-Séquard/fisiopatología , Síndrome de Brown-Séquard/cirugía
3.
Pract Neurol ; 17(1): 6-12, 2017 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-27872169

RESUMEN

The diagnosis of spinal cord disease may be delayed or missed if the presentation does not conform to the expected pattern of a symmetrical spastic paraparesis with sphincter dysfunction and a sensory level. This may occur when a myelopathy has yet to evolve fully, or is highly asymmetrical, as in Brown-Séquard syndrome. Other potential distractions include fluctuating symptoms, as may accompany spinal cord demyelination, and pseudoneuropathic features, as seen acutely in spinal shock and in the chronic setting with some high cervical cord lesions. A second pathology, such as a polyneuropathy or polyradiculopathy, can mask the presence of a myelopathy. The converse situation, of non-myelopathic disease mimicking a cord lesion, arises typically when symptoms and/or signs approximate bilateral symmetry. This may happen with certain diseases of the brain, or of the peripheral nerves, with functional disorders and even occasionally with non-neurological disease. These sources of diagnostic difficulty assume clinical importance when they delay the recognition of conditions that require urgent treatment.


Asunto(s)
Síndrome de Brown-Séquard/diagnóstico por imagen , Trastornos de Conversión/diagnóstico por imagen , Enfermedades de la Médula Espinal/diagnóstico por imagen , Adulto , Anciano , Síndrome de Brown-Séquard/complicaciones , Síndrome de Brown-Séquard/fisiopatología , Trastornos de Conversión/complicaciones , Trastornos de Conversión/fisiopatología , Diagnóstico Diferencial , Ejercicio Físico/fisiología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Enfermedades de la Médula Espinal/complicaciones , Enfermedades de la Médula Espinal/fisiopatología
4.
Appl Neuropsychol Adult ; 23(6): 418-25, 2016.
Artículo en Inglés | MEDLINE | ID: mdl-27183008

RESUMEN

We developed a functional semi-structured scale to observe Hemineglect symptoms in Activities of Daily Living (H-ADL). The scale could assist clinicians in assessing rehabilitation priorities aimed at correcting any persisting errors or omissions. In addition, the scale could also be used by caregivers to observe patients' progress and improve their participation. Two groups of right brain-damaged patients (25 with hemineglect; 27 without hemineglect) were tested twice: at admission and before discharge from hospital. A control group of healthy individuals matched to patients for age and education and patients' caregivers also participated. Two raters (A; B), experts in neuropsychology, observed patients and healthy individuals using the H-ADL. We found that the H-ADL final scores correlated with the standard hemineglect tests. The three groups differed in performance and differences also emerged between the first and the second assessment, suggesting an improvement due to the remission of hemineglect as a consequence of the treatment. Raters A and B did not differ in their observations, but there were some discrepancies with caregivers' observations. Therefore, although caregivers could help clinicians in detecting persistent hemineglect behaviour, the assessment should be performed by experts in neuropsychology.


Asunto(s)
Actividades Cotidianas/psicología , Síndrome de Brown-Séquard/fisiopatología , Síndrome de Brown-Séquard/psicología , Cuidadores/psicología , Lectura , Anciano , Anciano de 80 o más Años , Análisis de Varianza , Síndrome de Brown-Séquard/diagnóstico , Estudios de Casos y Controles , Femenino , Lateralidad Funcional , Humanos , Masculino , Persona de Mediana Edad , Pruebas Neuropsicológicas , Estadística como Asunto
5.
Spine (Phila Pa 1976) ; 41 Suppl 7: S27, 2016 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-27015067

RESUMEN

Spinal cord injury (SCI) can be complete or incomplete. The level of injury in SCI is defined as the most caudal segment with motor function rated at greater than or equal to 3/5, with pain and temperature preserved. The standard neurological classification of SCI provided by the American Spinal Injury Association (ASIA) assigns grades from ASIA A (complete SCI) through ASIA E (normal sensory/motor), with B, C, and D representing varying degrees of injury between these extremes. The most common causes of SCI include trauma (motor vehicle accidents, sports, violence, falls), degenerative spinal disease, vascular injury (anterior spinal artery syndrome, epidural hematoma), tumor, infection (epidural abscess), and demyelinating processes (). (SDC Figure 1, http://links.lww.com/BRS/B91)(Figure is included in full-text article.).


Asunto(s)
Síndrome de Brown-Séquard , Síndrome del Cordón Central , Heridas por Arma de Fuego , Síndrome de Brown-Séquard/diagnóstico por imagen , Síndrome de Brown-Séquard/etiología , Síndrome de Brown-Séquard/fisiopatología , Síndrome del Cordón Central/diagnóstico por imagen , Síndrome del Cordón Central/etiología , Síndrome del Cordón Central/fisiopatología , Humanos , Heridas por Arma de Fuego/complicaciones , Heridas por Arma de Fuego/diagnóstico por imagen
6.
Proc Natl Acad Sci U S A ; 112(52): 16024-9, 2015 Dec 29.
Artículo en Inglés | MEDLINE | ID: mdl-26655739

RESUMEN

Topographic maps and their continuity constitute a fundamental principle of brain organization. In the somatosensory system, whole-body sensory impairment may be reflected either in cortical signal reduction or disorganization of the somatotopic map, such as disturbed continuity. Here we investigated the role of continuity in pathological states. We studied whole-body cortical representations in response to continuous sensory stimulation under functional MRI (fMRI) in two unique patient populations-patients with cervical sensory Brown-Séquard syndrome (injury to one side of the spinal cord) and patients before and after surgical repair of cervical disk protrusion-enabling us to compare whole-body representations in the same study subjects. We quantified the spatial gradient of cortical activation and evaluated the divergence from a continuous pattern. Gradient continuity was found to be disturbed at the primary somatosensory cortex (S1) and the supplementary motor area (SMA), in both patient populations: contralateral to the disturbed body side in the Brown-Séquard group and before repair in the surgical group, which was further improved after intervention. Results corresponding to the nondisturbed body side and after surgical repair were comparable with control subjects. No difference was found in the fMRI signal power between the different conditions in the two groups, as well as with respect to control subjects. These results suggest that decreased sensation in our patients is related to gradient discontinuity rather than signal reduction. Gradient continuity may be crucial for somatotopic and other topographical organization, and its disruption may characterize pathological processing.


Asunto(s)
Síndrome de Brown-Séquard/fisiopatología , Vértebras Cervicales/fisiopatología , Desplazamiento del Disco Intervertebral/fisiopatología , Corteza Somatosensorial/fisiopatología , Adulto , Mapeo Encefálico , Vértebras Cervicales/cirugía , Femenino , Humanos , Desplazamiento del Disco Intervertebral/cirugía , Imagen por Resonancia Magnética/métodos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Corteza Somatosensorial/patología , Adulto Joven
7.
Occup Med (Lond) ; 65(9): 758-60, 2015 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-26400970

RESUMEN

Neurological decompression sickness (DCS) is a rare condition that commonly leads to spinal cord injury. We report the case of a 30-year-old man who developed left-sided weakness and numbness after diving to a maximum depth of 15 m with a total dive time of 205min (10 repetitive dives). To the best of our knowledge, only six cases diagnosed as Brown-Séquard syndrome caused by DCS have been reported in the literature. Divers should be aware of the risk factors of DCS before diving and clinicians should make the diagnosis of spinal cord DCS based primarily on clinical symptoms, not on magnetic resonance imaging findings.


Asunto(s)
Síndrome de Brown-Séquard/diagnóstico , Industria de la Construcción , Enfermedad de Descompresión/diagnóstico , Buceo/efectos adversos , Oxigenoterapia Hiperbárica/métodos , Enfermedades Profesionales/diagnóstico , Exposición Profesional/efectos adversos , Adulto , Síndrome de Brown-Séquard/etiología , Síndrome de Brown-Séquard/fisiopatología , Síndrome de Brown-Séquard/terapia , Enfermedad de Descompresión/complicaciones , Enfermedad de Descompresión/fisiopatología , Enfermedad de Descompresión/terapia , Humanos , Imagen por Resonancia Magnética , Masculino , Enfermedades Profesionales/fisiopatología , Enfermedades Profesionales/terapia , Pronóstico , Factores de Riesgo
10.
Spinal Cord ; 51(10): 794-6, 2013 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-23752266

RESUMEN

STUDY DESIGN: A case report. OBJECTIVES: To present a case of postpartum hypogalactia in a woman with Brown-Séquard-plus syndrome (BSPS). SETTING: Outpatient spinal cord injury (SCI) clinic. CASE REPORT: A 33-year-old woman with C4 AIS D tetraplegia (American Spinal Injury Association Impairment Scale) was followed at the outpatient SCI clinic for the past 5 years. Her right side presents with increased tone, increased spasticity and decreased sensitivity to light touch. Conversely, her left side presents with minimal changes in tone and no motor function deficits, but decreased sensitivity to pinprick and temperature sensation. These findings are consistent with BSPS. After inpatient rehabilitation, she was engaged, married, and 8 months ago delivered a healthy child. After an uncomplicated delivery, breastfeeding was attempted, but a significant lack of lactation was noted the first month postpartum from the right breast. Despite the implementation of measures to increase lactation, the lack of lactation from the right breast persisted, and required initiation of formula feeding. The right breast in this case lost not only sensory proprioception, but also autonomic control, which could contribute to this instance of asymmetric lactation. CONCLUSION: In addition to motor and sensory dysfunctions following SCI, autonomic dysfunctions are commonly seen in individuals with these devastating injuries. The lactation on the right side, which had interrupted descending spinal autonomic pathways, was decreased by approximately 83%. This case provides us with interesting information regarding attention that clinicians should be paying when discussing the breastfeeding options for women with SCI.


Asunto(s)
Síndrome de Brown-Séquard/etiología , Trastornos de la Lactancia/etiología , Periodo Posparto , Traumatismos de la Médula Espinal/complicaciones , Adulto , Lactancia Materna , Síndrome de Brown-Séquard/diagnóstico , Síndrome de Brown-Séquard/fisiopatología , Femenino , Humanos , Trastornos de la Lactancia/fisiopatología , Trastornos de la Lactancia/terapia , Traumatismos de la Médula Espinal/fisiopatología , Resultado del Tratamiento
11.
Disabil Rehabil ; 35(22): 1869-76, 2013.
Artículo en Inglés | MEDLINE | ID: mdl-23600711

RESUMEN

PURPOSE: This is a pilot study with the aim to highlight the use of kinematic and kinetic analyses as an adjunct to the assessment of individual patients with central cord syndrome (CCS) and hemisection or Brown-Séquard syndrome (BSS) and to discuss their possible consequences for clinical management. METHODS: The sample studied consisted of 17 patients with CCS, 13 with BSS and 20 control subjects (control group (CG)). Data were obtained using a three-dimensional motion analysis system and two force plates. Gait differences were compared between CCS, BSS walking at a self-selected speed and CG at both a self-selected and a similar speed to that of the patient groups. RESULTS: The most relevant findings involved the knee and ankle, especially in the sagittal plane. In patients with CCS, knee flexion at initial contact was increased with respect to those in the BSS group (p < 0.01). The ankle in the BSS group made initial contact with a small degree of plantar flexion. CONCLUSION: The use of gait biomechanical analysis to detect underlying impairments can help the physician to set a specific rehabilitation program in each CCS and BSS walking patient. In this group of patients, rehabilitation treatment should aim to improve gait control and optimise ankle positioning at initial contact. Implications for Rehabilitation In this study, gait differences between patients with CSS and BSS were evaluated with biomechanical equipment. The most remarkable differences were found in the knee and ankle sagittal plane due to ankle position at initial contact. In this group of patients, rehabilitation treatment should aim to improve gait control and to get a better ankle positioning at initial contact.


Asunto(s)
Síndrome de Brown-Séquard/fisiopatología , Síndrome del Cordón Central/fisiopatología , Marcha/fisiología , Caminata/fisiología , Adulto , Análisis de Varianza , Articulación del Tobillo/fisiología , Fenómenos Biomecánicos/fisiología , Síndrome de Brown-Séquard/rehabilitación , Estudios de Casos y Controles , Síndrome del Cordón Central/rehabilitación , Evaluación de la Discapacidad , Femenino , Articulación de la Cadera/fisiología , Humanos , Articulación de la Rodilla/fisiología , Masculino , Persona de Mediana Edad
12.
J Neurosurg Sci ; 57(1): 81-6, 2013 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-23584224

RESUMEN

Brown-Séquard plus syndrome (BSPS) or incomplete spinal cord injuries from stab injury have been widely reported. However, only four detailed cases of pure Brown-Séquard syndrome (BSS) from stab injury have been previously reported. Here we present the case of an 18-year-old man who sustained a penetrating knife stab injury to the right side of his back resulting in a pure Brown-Séquard syndrome with left lower extremity hemiplegia. Imaging revealed right-sided soft tissue and ligamentous damage traveling in a right-to-left fashion as well as left-sided T2-weighted MRI cord signal change at the level of T9. Given concern for a cerebrospinal fluid leak (CSF) leak, the patient was taken for wound exploration, irrigation, laminectomy, dural closure and lumbar drain placement. At three years follow up, the patient was almost full strength. This is the first case in the literature demonstrating radiographic and correlative intraoperative imaging of a hemisection of the spinal cord resulting in a pure Brown-Séquard syndrome.


Asunto(s)
Síndrome de Brown-Séquard/cirugía , Laminectomía/métodos , Traumatismos de la Médula Espinal/cirugía , Heridas Punzantes/cirugía , Adolescente , Síndrome de Brown-Séquard/diagnóstico por imagen , Síndrome de Brown-Séquard/fisiopatología , Humanos , Imagen por Resonancia Magnética , Masculino , Traumatismos de la Médula Espinal/diagnóstico por imagen , Traumatismos de la Médula Espinal/etiología , Vértebras Torácicas/diagnóstico por imagen , Vértebras Torácicas/lesiones , Vértebras Torácicas/cirugía , Tomografía Computarizada por Rayos X , Resultado del Tratamiento , Heridas Punzantes/complicaciones , Heridas Punzantes/diagnóstico por imagen
13.
Eur Spine J ; 21 Suppl 4: S418-21, 2012 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-21674209

RESUMEN

INTRODUCTION: Brown-Sequard syndrome is an incomplete spinal cord lesion characterized by ipsilateral loss of motor function and contralateral loss of pain and temperature sensitivity, reflecting a hemi-compression or hemi-section of the spinal cord. Cervical disc herniation is an exceptional cause of this syndrome. MATERIAL AND METHODS: We report a case of cervical disc herniation causing Brown-Sequard syndrome in a patient with an unusually rapid neurological deterioration associated to cervical extension, which was documented by neuromonitoring. CONCLUSION: A prompt diagnosis, followed by spinal cord decompression should be warranted. Intraoperative neuromonitoring is a useful tool in preservation of neurologic function in these cases.


Asunto(s)
Síndrome de Brown-Séquard/etiología , Desplazamiento del Disco Intervertebral/complicaciones , Síndrome de Brown-Séquard/fisiopatología , Síndrome de Brown-Séquard/cirugía , Vértebras Cervicales/cirugía , Discectomía , Potenciales Evocados Motores/fisiología , Potenciales Evocados Somatosensoriales/fisiología , Humanos , Desplazamiento del Disco Intervertebral/fisiopatología , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Monitoreo Intraoperatorio , Fusión Vertebral , Resultado del Tratamiento
14.
NeuroRehabilitation ; 29(4): 353-7, 2011.
Artículo en Inglés | MEDLINE | ID: mdl-22207062

RESUMEN

STUDY DESIGN: Case report. OBJECTIVE: To describe a patient presenting with Brown-Séquard-plus syndrome treated in a conservative manner and to discuss the possible physiopathological mechanisms causing the injury. METHODS: The case study of a 35-year-old woman who entered the hospital with a knife that had penetrated her neck through the left upper thoracic aperture and with a rising, back, right oblique trajectory. This patient developed Brown-Séquard-plus syndrome on the right side of her body. RESULTS: The initial computerized tomography (CT) demonstrated that the tip of the knife was inside the right C7 vertebral foramen, which not dissected the vertebral artery. The initial magnetic resonance imaging (MRI) and the MRI done 3 weeks later showed the presence of spinal cord ischemia on the right side at the C6-C7 level. This spinal cord ischemia was most likely caused after a vessel spasm of the vertebral artery. After conservative treatment, the patient evolved from a C rating on the ASIA scale to a D rating. CONCLUSION: In our department, spinal cord injuries after stab wounds are very rare, and they usually cause incomplete lesions that eventually lead to Brown-Séquard syndrome. In our patient, the spinal cord injury was due to a vasospasm of the vertebral artery, which was accompanied by good functional prognosis. MRI helped to define the physiopathologic mechanism of the injury and guided the appropriate treatment decision.


Asunto(s)
Síndrome de Brown-Séquard/etiología , Síndrome de Brown-Séquard/fisiopatología , Traumatismos de la Médula Espinal/complicaciones , Heridas Punzantes/complicaciones , Adulto , Femenino , Humanos , Imagen por Resonancia Magnética , Tomografía Computarizada por Rayos X
15.
J Spinal Cord Med ; 34(4): 432-6, 2011.
Artículo en Inglés | MEDLINE | ID: mdl-21903018

RESUMEN

BACKGROUND: Spontaneous spinal epidural hematoma (SSEH) is an uncommon clinical entity. It produces a severe neurological deficit and prompt decompression is usually the first choice of treatment. Brown-Séquard syndrome is commonly seen in the setting of spinal trauma or an extramedullary spinal neoplasm, but rarely caused by SSEH. METHODS: Case report and literature review. FINDINGS: A previously healthy man presented with Brown-Séquard syndrome below T5-T6 cord segment secondary to spontaneous epidural hematoma. He opted for conservative treatment, which was followed by rapid resolution. CONCLUSIONS: Although Brown-Séquard syndrome as a presenting feature of SSEH is rare, it does exist in exceptional case, which should be taken into consideration for differential diagnosis. Prompt surgical decompression is an absolute surgical indication widely accepted for patient with progressive neurological deficit. However, SSEH presenting with incomplete neurological insult such as Brown-Séquard syndrome might have a benign course. Successful non-operative management of this problem does not make it a standard of care, and surgical decompression remains the standard treatment for SSEH.


Asunto(s)
Síndrome de Brown-Séquard/fisiopatología , Hematoma Espinal Epidural/diagnóstico , Médula Espinal/patología , Adulto , Humanos , Imagen por Resonancia Magnética , Masculino , Vértebras Torácicas
16.
Brain ; 134(Pt 8): 2261-73, 2011 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-21752788

RESUMEN

Cervical incomplete spinal cord injuries often lead to severe and persistent impairments of sensorimotor functions and are clinically the most frequent type of spinal cord injury. Understanding the motor impairments and the possible functional recovery of upper and lower extremities is of great importance. Animal models investigating motor dysfunction following cervical spinal cord injury are rare. We analysed the differential spontaneous recovery of fore- and hindlimb locomotion by detailed kinematic analysis in adult rats with unilateral C4/C5 hemisection, a lesion that leads to the Brown-Séquard syndrome in humans. The results showed disproportionately better performance of hindlimb compared with forelimb locomotion; hindlimb locomotion showed substantial recovery, whereas the ipsilesional forelimb remained in a very poor functional state. Such a differential motor recovery pattern is also known to occur in monkeys and in humans after similar spinal cord lesions. On the lesioned side, cortico-, rubro-, vestibulo- and reticulospinal tracts and the important modulatory serotonergic, dopaminergic and noradrenergic fibre systems were interrupted by the lesion. In an attempt to facilitate locomotion, different monoaminergic agonists were injected intrathecally. Injections of specific serotonergic and noradrenergic agonists in the chronic phase after the spinal cord lesion revealed remarkable, although mostly functionally negative, modulations of particular parameters of hindlimb locomotion. In contrast, forelimb locomotion was mostly unresponsive to these agonists. These results, therefore, show fundamental differences between fore- and hindlimb spinal motor circuitries and their functional dependence on remaining descending inputs and exogenous spinal excitation. Understanding these differences may help to develop future therapeutic strategies to improve upper and lower limb function in patients with incomplete cervical spinal cord injuries.


Asunto(s)
Síndrome de Brown-Séquard/fisiopatología , Lateralidad Funcional/fisiología , Trastornos del Movimiento/etiología , Recuperación de la Función/fisiología , Traumatismos de la Médula Espinal/complicaciones , 8-Hidroxi-2-(di-n-propilamino)tetralin/uso terapéutico , Animales , Apomorfina/uso terapéutico , Clonidina/uso terapéutico , Modelos Animales de Enfermedad , Agonistas de Dopamina/uso terapéutico , Interacciones Farmacológicas , Femenino , Metoxamina/uso terapéutico , Actividad Motora/efectos de los fármacos , Neuronas Motoras/patología , Neuronas Motoras/fisiología , Trastornos del Movimiento/tratamiento farmacológico , Quipazina/uso terapéutico , Ratas , Ratas Endogámicas Lew , Recuperación de la Función/efectos de los fármacos , Serotonina/metabolismo , Agonistas de Receptores de Serotonina/uso terapéutico , Traumatismos de la Médula Espinal/tratamiento farmacológico , Traumatismos de la Médula Espinal/patología , Simpaticolíticos/uso terapéutico , Simpatomiméticos/uso terapéutico , Tirosina 3-Monooxigenasa/metabolismo
17.
Acta Neurol Taiwan ; 19(3): 204-7, 2010 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-20824542

RESUMEN

PURPOSE: Lateral medullary infarction is not uncommon in clinical practice of neurology. This report describes a patient who initially presented with Brown-Séquard syndrome-like manifestation but was later diagnosed with acute infarction in the left lower lateral medulla. CASE REPORT: A 65-year-old woman presented with acute onset of unsteadiness, left side hemiparesis, left limb dysmetria, left side partial Horner syndrome, and paresthesia in the right lower limb and trunk with a sensory level at T5 on the right. No bulbar symptoms nor facial paresthesia was noted. Brown- Séquard syndrome was suspected initially, but cervical spine magnetic resonance imaging showed only mild spinal stenosis. Brain magnetic resonance imaging revealed acute infarction in the left lower lateral medulla. The mechanism of this unusual presentation is discussed. CONCLUSION: Brown-Séquard syndrome-like manifestation can be a rare presentation of lower lateral medullary infarction.


Asunto(s)
Infartos del Tronco Encefálico/diagnóstico , Síndrome de Brown-Séquard/fisiopatología , Bulbo Raquídeo/patología , Anciano , Femenino , Humanos , Imagen por Resonancia Magnética/métodos
20.
Spinal Cord ; 48(8): 614-8, 2010 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-20065980

RESUMEN

STUDY DESIGN: Prospective multi-center cohort study. OBJECTIVES: To compare the neurological and functional recovery between tetraplegic Brown-Séquard-plus syndrome (BSPS) and incomplete tetraplegia (non-BSPS). SETTING: European Multicenter Study of Human Spinal Cord Injury (EM-SCI). METHODS: BSPS was defined as a traumatic incomplete spinal cord injury (SCI) with ipsilateral weakness and contralateral loss of pinprick sensation at neurologic levels C2-T1. Acute (0-15 days) and chronic phase (6 or 12 months) were assessed for the American Spinal Injury Association (ASIA) sensory scores, upper extremity motor scores and lower extremity motor scores. Furthermore, chronic phase scores of all Spinal Cord Independence Measure (SCIM) II items were analyzed. Differences in neurological and functional outcome between BSPS patients and non-BSPS patients were calculated using Student's t-tests and Wilcoxon signed rank tests. RESULTS: Out of 148 tetraplegic patients, 30 were diagnosed with BSPS. Patients with an ASIA impairment scale (AIS) B were significantly (P<0.001) more identified in non-BSPS patients (25%) compared with BSPS patients (3%), respectively. After 12 months, the median scores for sphincter management of the bladder for both BSPS and non-BSPS patients were 15. Both 25 and 75% quartile median scores were 15 for BSPS patients and 12 and 15 for non-BSPS patients (P<0.02). Except for the difference in bladder function, no significant differences were identified in other SCIM II subitems and ASIA motor or sensory scores between BSPS and non-BSPS patients when stratified for injury severity by excluding AIS B patients. CONCLUSION: Compared with incomplete tetraplegic patients, patients with cervical BSPS have a similar neurological and functional recovery when matched for the AIS.


Asunto(s)
Síndrome de Brown-Séquard/fisiopatología , Evaluación de la Discapacidad , Recuperación de la Función/fisiología , Traumatismos de la Médula Espinal/fisiopatología , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Síndrome de Brown-Séquard/diagnóstico , Síndrome de Brown-Séquard/epidemiología , Estudios de Cohortes , Europa (Continente)/epidemiología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Examen Neurológico/métodos , Evaluación de Resultado en la Atención de Salud/métodos , Valor Predictivo de las Pruebas , Estudios Prospectivos , Índice de Severidad de la Enfermedad , Traumatismos de la Médula Espinal/diagnóstico , Traumatismos de la Médula Espinal/epidemiología , Adulto Joven
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