Chapter 6 - Van Nguyen: A 36-year-old Male With the Inability to Feel Temperature Below the Umbilicus on the Right With Associated Upper and Lower Extremity Weakness

Abstract

Brown-Sequard syndrome is the eponym given to the clinical picture of ipsilateral upper motor neuron paralysis and loss of proprioception combined with the loss of contralateral pain and temperature sensation. The syndrome is caused by an incomplete spinal cord lesion characterized by the findings one would expect with hemisection of the spinal cord. Often additional symptoms may accompany Brown-Sequard syndrome and may confuse the clinical picture. This scenario is referred to as Brown-Sequard syndrome-plus. The organization of the spinal cord explains the clinical findings of Brown-Sequard syndrome. The motor fibers of the corticospinal tracts decussate at the junction of the medulla and spinal cord. The ascending dorsal column, which carries vibration and position information, runs ipsilateral to the roots ofc entry and crosses above the spinal cord in the medulla. The spinothalamic tracts carry pain, temperature, and crude touch sensations from the contralateral side of the body. Nerve roots and/or anterior horn cells at the injury site also may be affected, leading to Brown-Sequard syndrome plus.