Cervical Stenosis Presenting With Acute Brown-Séquard Syndrome

Abstract

An unusual case report of cervical stenosis presenting with the Brown-Séquard syndrome. Technical considerations and a literature review are discussed. To evaluate cervical stenosis as an etiology of the Brown-Séquard syndrome and whether surgical decompression is effective for improving neurologic outcome. Of the causes of the Brown-Séquard syndrome, intrinsic cervical spine pathology has rarely been reported in the literature. We report the first case of a chronic cervical stenosis presenting with an acute Brown-Séquard syndrome after a severe coughing episode. A 75-year-old woman with a previous history of cervical stenosis had sudden onset of weakness develop in the right upper and lower extremities, and disruption of pain and temperature sensation on the left side of her body after an episode of severe coughing associated with pneumonia. Magnetic resonance imaging of the cervical spine revealed severe canal stenosis from C3 through C7, with diffuse intramedullary hyperintensity consistent with myelomalacia of the cervical cord. A decompressive cervical laminectomy with fusion was performed. The patient improved neurologically, with near complete resolution of the right hemiparesis at 6-month follow-up. Multilevel chronic cervical stenosis can present with an acute Brown-Séquard syndrome. Cervical laminectomy and decompression are effective treatments for cervical stenosis with an acute Brown-Séquard syndrome.