Brown sequard syndrome as a manifestation of acute spontaneous spinal haematoma: A diagnostic challenge

Abstract

Brown-Sequard Syndrome (BSS) is a neurological disorder caused by hemisection lesion of the spinal cord. BSS causes can be dichotomized in traumatic and atraumatic, and they can include vascular causes, as ischemia or haemorrhage. We describe the case of a 52-year-old woman presenting with limbs paraesthesia and right leg hyposthenia, associated with cervical acute nontraumatic pain (C6-C7 level). Neurological consultant was requested with a suspicious of vertebral artery dissection: clinical examination revealed right leg flaccid weakness, loss of pain and temperature sensation in left hemisoma, hypopallesthesia of right limbs and T1-T2 sensory level. Those symptoms were suggestive of a Brown Sequard Syndrome. MRI showed an epidural haematoma compressing spinal cord, associated with abnormal signal to C6-C7 and D1 level of spinal cord. Urgent laminectomy and evacuation were performed. Neurological symptoms improved avoiding permanent paraplegia