FES-rowing: a well-tolerated and highly beneficial exercise for a patient with Brown-Sequard syndrome.

CONTEXT: Brown-Séquard Syndrome (BSS) is a rare neurological condition associated with Spinal Cord Injury (SCI). Hemisection of the spinal cord causes paralysis of the homolateral side, and thermoalgesic dysfunction on the opposite side. Cardiopulmonary and metabolic alterations have been reported. For all these patients, regular physical activity is highly recommended and functional electrical stimulation (FES) may be a good option, especially for those with paraplegia. However, to our knowledge, the effects of FES have primarily been studied in those with complete SCI and data regarding application and effects in patients with incomplete lesions (with sensory feedback) is lacking. The present case report therefore evaluated the feasibility and effectiveness of a 3-month FES-rowing program in a patient with BSS. METHODS: Knee extensor muscle strength and thickness, walking and rowing capacities as well as quality of life were evaluated before and after 3 months of FES-rowing (two sessions per week) in a 54 year old patient with BSS. RESULTS: The individual had excellent tolerance and adherence to the training protocol. All measured parameters were greatly improved after 3 months: on average, + 30% rowing capacity, + 26% walking capacity, + 24.5% isometric strength, + 21.9% quadriceps muscle thickness, + 34.5% quality of life. CONCLUSION: FES-rowing appears to be well tolerated and highly beneficial for a patient with incomplete SCI and could therefore be considered as an appealing exercise option for these patients.

Conservative Management of Traumatic Brown-Séquard Syndrome: A Case Report.

BACKGROUND Traumatic spinal cord injuries are quite common; however, a rare form of incomplete spinal cord injury is Brown-Sequard syndrome. Brown-Sequard syndrome is defined by the National Institute of Neurological Disorders and Strokes as "a rare neurological condition characterized by a lesion in the spinal cord which results in weakness or paralysis (hemiparaplegia) on one side of the body and a loss of sensation (hemianesthesia) on the opposite side." CASE REPORT A 33-year-old man was brought to the Emergency Department by Saudi Red Crescent with multiple stab wounds on the left upper thoracic and lower cervical regions. He was tachycardic, but otherwise vitally stable. His Glasgow Coma Scale score was 15. The patient presented with bilateral lower limb weakness, more on the ipsilateral (left) side, and contralateral (right) hypoesthesia from the level of the nipple below. Cervical and thoracic magnetic resonance imaging revealed ligamentous injury defect at the posterior dura and indicating a dural tear with minor cerebrospinal fluid leak. Focal hyperintense signal intensity was noted on the left side of the spinal cord, representing contusion. The patient was managed conservatively with daily physical therapy. Strength had improved substantially by the time of discharge and sensation was improving. CONCLUSIONS Brown-Sequard syndrome is associated with good prognosis. These patients require a multidisciplinary approach because it provides the best chance of recovery to pre-injury status. These injuries may cause disastrous neurological deficits; therefore, preventive strategies should be designated to decrease the incidence of such injuries.

Acquired Spinal Arteriovenous Fistula Presenting as Brown-Séquard Syndrome and Endovascular Treatment Outcome.

BACKGROUND: Brown-Séquard syndrome is typically caused by penetrating trauma to the cervical spinal cord; however, other compressive and vascular occlusive etiologies have been previously described. It is extremely uncommon to have a delayed presentation as an extramedullary compressive lesion from the venous varix of an acquired spinal arteriovenous fistula. CASE DESCRIPTION: We present a case of a patient in the fifth decade of life, with a remote history of gunshot wound to the left thorax with progressive left-sided weakness and contralateral pain and temperature sensory loss secondary to cord compression from an acquired spinal arteriovenous fistula. CONCLUSIONS: Subsequent treatment occurred with coil embolization with good outcome.

Brown-Séquard syndrome: a rare manifestation of decompression sickness.

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.

Spinal stab injury with retained knife blades: 51 Consecutive patients managed at a regional referral unit.

BACKGROUND: Spinal stab wounds presenting with retained knife blades (RKB) are uncommon, often resulting in spinal cord injury (SCI) with catastrophic neurological consequences. The purpose of this study is to report a single unit's experience in management of this pattern of injury at this regional referral centre. METHODS: Retrospective review of medical records identified 51 consecutive patients with spinal stabs presenting with a RKB at the Neurosurgery Department at Inkosi Albert Luthuli Central Hospital between January 2003 and February 2015. The data was analyzed for patient characteristics, level of the RKB, neurological status using the ASIA impairment scale, associated injuries, radiological investigations, management, hospital length of stay, complications and mortality. RESULTS: The mean age was 28±10.9 years (range 14-69), with 45 (88%) males (M: F=7.5:1). The median Injury Severity Score was 16 (range 4-26). RKB were located in the cervical [9,18%], thoracic [38,74%], lumbar [2,4%] and sacral [2,4%] spine. Twelve patients (24%) sustained complete SCI (ASIA A), while 21 (41%) had incomplete (ASIA B, C, D), of which 17 had features of Brown-Sequard syndrome. Eighteen (35%) patients were neurologically intact (ASIA E). There were 8 (16%) associated pneumothoraces and one vertebral artery injury. Length of hospital stay was 10±7.1 days (range 1-27). One patient (2%) died during this period. CONCLUSIONS: Stab injuries to the spine presenting with RKB are still prevalent in South Africa. Resources should be allocated to prevention strategies that decrease the incidence of inter-personal violence. All RKBs should be removed in the operating theatre by experienced surgeons to minimise complications.

Management of Brown-Sequard syndrome in cervical disc diseases.

AIM: To raise the awareness of the appropriate management of unusual clinical presentation of cervical disc herniation. MATERIAL AND METHODS: Seven patients with Brown-Sequard syndrome due to cervical disc herniation presented with Brown-Sequard syndrome had been treated surgically as one of them treated with anterior cervical discectomy and three patients treated by anterior cervical discectomy and fusion while three of them have been treated by posterior laminectomy. RESULTS: Patients were 7 three of them were female and four were males and the mean age of our patients is 45.28 ± 16.49 years ranged between 32 and 72 years. History of spinodegenerative disease in the form of chronic neck pain with or without brachialgia was found in 6/7 patients (85.7%) while history of trauma was found in 5/7 patients (71.4%). Most common affected level is C5-C6 disc Outcome after surgical treatment revealed complete recovery in 4/7 patients (57.1%) while incomplete recovery in 2 patients (28.6%) and no improvement in one patient (14.3%). CONCLUSION: Brown-Sequard syndrome is a rare presentation of cervical disc herniation but accurate diagnosis, and early anterior spinal cord decompression lead to complete recovery of these cases.

Stab wound in cervical spine causing Brown-Séquard syndrome: case report

Introduction: To report a case of cervical spinal cord injury due to stab wounds, with the development of the Brown-Séquard syndrome. Methods: We analyzed clinical and imaging, as well as conduits for the case of a 22 year-old man, victim of physical aggression by stab wound in the neck. Results: Tetraparesis, contralateral deficit of thermal and pain sensitivities below the lesion and ipsilateral motor and proprioception deficits are justified by the findings on imaging studies. A CT scan of the cervical spine revealed a hyperdense lesion between C3-C4. The MRI, in turn, showed the presence of right paravertebral hematoma and partial spinal cord injury between C3 and C4. The moderate neurological deficit persisted at discharge from hospital. Conclusion: Spinal cord injuries due to stab wounds are uncommon when compared to those caused by other factors such as traffic accidents, falls and gunshot injury. The neurological presentation of Brown-Séquard syndrome has been reported as rare in medical literature. Its treatment in most cases is conservative and the prognosis is better when it comes from stab injury rather than other causes.

MRI features of spinal cord decompression sickness presenting as a Brown-Sequard syndrome.

Decompression sickness often manifests as central nervous system impairment. We report a 49-year-old woman who developed an unusual case of spinal cord decompression sickness presenting as complete Brown-Sequard syndrome. Initial MRI revealed increased signal intensity in the left side of the cervical cord at the level of C2-C3. A second MRI at 10 days post-injury showed signal abnormalities corresponding to an infarction in the posterior spinal artery territory. After two weeks of intensive treatment with various HBOT regimens, the clinical outcome was still poor, but at six months after the injury her neurological condition was greatly improved, with only slight impairment of proprioception on the left when walking remaining.

Cervical disc herniation and Brown-Sequard syndrome: a case report.

Brown-Sequard syndrome caused by herniated cervical disc is relatively rare. We report a 45 year old female patient who presented with weakness of the right extremities and absent pain and temperature sensation on the left below the C4 dermatome. CT myelogram revealed disc herniation between C3/C4, C4/C5 and C5/C6 disc spaces but was worst at C4/C5 with anterior cord compression and evidence of posterior osteophytes on the C5 and C6 cervical vertebrae. Patient responded well to symptomatic and supportive therapy including physiotherapy. She declined surgical intervention which is usually recommended in discogenic Brown-Sequard syndrome.

Brown-Séquard syndrome following removal of a cerebrospinal fluid drainage catheter after thoracic aortic surgery.

UNLABELLED: Neurological deficit remains a devastating complication of thoracic aortic surgery despite advances in methods to protect the spinal cord from ischemia. Various techniques have been used, including the combination of cerebrospinal fluid (CSF) drainage and distal aortic perfusion to decrease the incidence of postoperative neurological deficit. These deficits are usually bilateral and result in paraplegia. In this case report we present a patient with Type B aortic dissection and thoracoabdominal aortic aneurysm repair with insertion of a lumbar CSF drainage catheter. Postoperatively, the patient developed unilateral neurological features consistent with Brown-Séquard syndrome after removal of the CSF catheter. The lumbar cerebrospinal fluid catheter was reinserted and the CSF was drained. Medullary T6-7 signal abnormalities were seen on spinal cord magnetic resonance imaging, and we suggest that the spinal cord suffered a direct injury during catheter removal. The patient had an uneventful recovery. IMPLICATIONS: We describe a patient who developed unilateral neurologic features suggestive of Brown-Sequard syndrome following removal of a cerebrospinal fluid catheter after thoracic aortic surgery. We suggest that the spinal cord was injured during catheter removal. The catheter was reinserted and the patient had a full neurologic recovery.

[Subtotal spinal cord dissection from a stab injury]. / Subtotale Rückenmarkdurchtrennung. Als Folge eines Messerstichs.

We report a stab-injury of the back with consecutive dissection of a thoracic vertebral arch and subtotal dissection of the spinal cord. The clinical findings and out-come of the patient--representing an incomplete Brown-Sequardsyndrome--are described. The diagnostic and therapeutic management of such rare entities is discussed.

Use of breath-activated Patient Controlled Analgesia for acute pain management in a patient with quadriplegia.

We report the use of breath-activated Patient Controlled Analgesia (PCA) for the provision of analgesia in a quadriplegic patient with traumatic neck injury. This provided good pain relief, decreased opioid complications, improved perceptions of self-control, smoothed recovery and enhanced patient, family as well as staff satisfaction. The setup and principles of its use in a patient with high anxiety and unable to use conventionally activated PCA are illustrated.

Brown-Sequard syndrome due to isolated blunt trauma.

Blunt trauma without associated fracture or ligamentous injury is a rare cause of Brown-Sequard syndrome. We report a case of Brown-Sequard syndrome after a direct blow to the cervical spine that did not cause injury to adjacent bone or ligaments. Characteristic neurologic findings, including a unilateral hemiparesis with associated contralateral sensory findings, were noted at the time of presentation. High-dose steroids were instituted after recognition of the patient's injury, and magnetic resonance imaging of the cervical spine revealed a unilateral cord contusion with no associated fractures. After 1 month, the patient had recovered much of his function and was able to ambulate unassisted.

Brown-Séquard syndrome of the cervical spinal cord after chiropractic manipulation.

We report a case of increased signal in the left hemicord at the C4 level on T2-weighted MR images after chiropractic manipulation, consistent with contusion. The patient displayed clinical features of Brown-Séquard syndrome, which stabilized with immobilization and steroids. Follow-up imaging showed decreased cord swelling with persistent increased signal. After physical therapy, the patient regained strength on the left side, with residual decreased sensation to pain involving the right arm.

Postvaccinial (influenza) disseminated encephalopathy (Brown-Sequard syndrome).

This article reports a case of Brown-Sequard syndrome that occurred in a patient following the administration of trivalent influenza vaccine. The patient responded well to intravenous steroids and physical therapy. This is the first reported case in the literature.