Brown-Sequard Syndrome

What is Brown-Séquard syndrome?

Brown-Séquard syndrome (BSS) is a rare neurological condition that happens when damage to your spinal cord causes muscle weakness or paralysis on one side of your body and a loss of sensation on the opposite side. The damage occurs on only one side of your spinal cord in a specific area.

Your spinal cord is a cylindrical structure that runs through the center of your spine, from your brainstem to your low back. It's a delicate structure that contains nerve bundles and cells that carry messages from your brain to the rest of your body and vice versa. Your spinal cord is one of the main parts of your nervous system.

Brown-Séquard syndrome is considered an incomplete spinal cord injury (SCI), meaning there’s partial preservation of sensory function, motor function or a combination of both below where the injury occurred on your spinal cord. A complete SCI results in the loss of all sensory and voluntary motor functions below the level of the injury.

BSS has several possible causes, but the most common cause is trauma — typically penetrating trauma such as a gunshot or stab wound. Inflammation or pinching of your spinal cord can also cause BSS occasionally.

Brown-Séquard syndrome is named after scientist Charles-Édouard Brown-Séquard, who first described it in 1849.

What is the difference between central cord syndrome and Brown-Séquard syndrome?

Central cord syndrome (CCS) and Brown-Séquard syndrome (BSS) are both incomplete spinal cord injuries, but they’re distinct conditions.

CCS is an incomplete traumatic injury to the center of your spinal cord, usually in your neck. This injury results in weakness in your arms that is worse than in your legs.

BSS results from an incomplete spinal cord injury anywhere along your spine, and it causes weakness or paralysis on one side of your body and a loss of sensation on the other side below where the injury is.

Who does Brown-Séquard syndrome affect?

Brown-Séquard syndrome can affect anyone, though it’s a rare condition. It affects people assigned female at birth and people assigned male at birth in equal numbers.

How common is Brown-Séquard syndrome?

Brown-Séquard syndrome is a rare condition.

Approximately 12,000 new cases of traumatic spinal cord injuries happen each year in the United States, and Brown-Séquard syndrome is estimated to result from 2% to 4% of these cases.

What are the symptoms of Brown-Séquard syndrome?

Symptoms of Brown-Séquard syndrome (BSS) usually appear after you experience spinal cord injury that causes damage on only one side of your spinal cord in a specific area anywhere along your spine.

The first symptoms of BSS are usually:

• Loss of voluntary motor function (muscle movement) on the same side of your body as the spinal cord damage below the level of the injury. This could present as weakness or paralysis.
• Loss of pain and temperature sensation on the other side of your body below the level of the injury.

For example, if someone had Brown-Séquard syndrome due to an injury that affected the right side of their spinal cord in their middle back, they would have a loss of muscle movement on the right side of their body from the middle of their back and down, which would affect their right hip, leg and foot. They would have a loss of pain and temperature sensation (but still have muscle control) on the left side of their body from their middle back and down. Their head, neck, shoulders and arms would be unaffected by the spinal cord damage and would function as they normally do.

BSS can also cause the following symptoms:

• Loss of bladder and bowel control (urinary and fecal incontinence).
• Weakness and muscle atrophy in the affected area.

The symptoms of BSS can vary from mild to severe. They generally improve with proper treatment of BSS.

Is Brown-Séquard syndrome painful?

If the cause of Brown-Séquard syndrome (BSS) is a traumatic event, such as a gunshot wound or vehicle collision, that event will cause pain. But the syndrome itself (the spinal cord injury) may not cause pain.

Some people with BSS may experience abnormal sensations (dysesthesia), such as a painful burning, prickling or aching feeling, due to the spinal cord injury.

What is the most common cause of Brown-Séquard syndrome?

The most common causes of Brown-Séquard syndrome (BSS) are traumatic injuries affecting your spinal cord, including:

• Gunshot wounds.
• Stab wounds.
• Motor vehicle accidents.
• Blunt trauma.
• Spinal fractures from an accident such as a fall.

If you experience any of these traumatic injuries, it’s important to get to the nearest hospital as soon as possible and receive immediate medical care.

There are several other less common causes of BSS that are due to non-traumatic conditions, including:

• Cervical (neck) spondylosis.
• Decompression sickness.
• Herniated disk.
• Meningitis.
• Multiple sclerosis (MS).
• Radiation exposure.
• Spinal ischemia (obstruction of a blood vessel).
• Spinal tumors.
• Transverse myelitis.
• Tuberculosis.

How is Brown-Séquard syndrome diagnosed?

If your healthcare provider suspects you may have Brown-Séquard syndrome (BSS), they’ll:

• Perform a thorough physical exam.
• Perform a neurological exam consisting of detailed motor and sensory evaluation.
• Ask detailed questions about your medical, neurological and trauma history.

Your provider will then order certain tests, such as an MRI scan, to confirm the diagnosis or rule out other possible causes of your symptoms.

What tests will be done to diagnose Brown-Séquard syndrome?

If your healthcare provider suspects you may have Brown-Séquard syndrome (BSS), they’ll likely order the following tests:

• Magnetic resonance imaging (MRI): This is a painless test that produces very clear images of the organs and structures within your body using a large magnet, radio waves and a computer. MRI is the most useful imaging test for BSS because it can help identify structural damage in your spine and can be useful in evaluating non-traumatic causes of BSS.
• Myelogram and computed tomography (CT) of your spine: If you’re unable to undergo an MRI scan, your provider will likely order a myelogram immediately followed by a CT scan of your spine. These tests can reveal nerve tissue damage on one side of your spinal cord. A myelogram is an imaging procedure that examines the relationship between the vertebrae and disks in your spinal column through your spinal cord, nerves and nerve roots. A CT scan uses X-rays and computers to produce detailed images of structures inside your body.
• Blood tests: If the cause of the BSS is unclear, your provider may order certain blood tests to check for an infection that might be causing the condition.
• Lumbar puncture (spinal tap): If your provider suspects that BSS is caused by multiple sclerosis, transverse myelitis or tuberculosis, they may perform a lumbar puncture to get a sample of cerebrospinal fluid (CSF) for analysis. CSF is the clear liquid that surrounds your spine and brain.

How is Brown-Séquard syndrome treated?

The treatment for Brown-Séquard syndrome (BSS) depends on the underlying cause of the spinal cord damage.

In general, the treatment goals for Brown-Séquard syndrome include:

• Preserving or improving motor and sensory function.
• Preventing secondary injuries.
• Minimizing complications.

People who have BSS as the result of a penetrating injury will need to be treated for bleeding and direct tissue damage. Similarly, people with BSS who have other injuries from the trauma that caused BSS will need additional treatment for those injuries.

There are two general phases of treatment for BSS, including initial treatment and rehabilitation.

Initial treatment of Brown-Séquard syndrome

General therapies for initial treatment of BSS may include:

• Surgery: Non-traumatic causes of BSS usually involve mechanical compression or herniation of your spinal cord that requires surgical treatment to alleviate the compression.
• Medication to prevent blood clots: People with spinal cord injuries have the highest rate of venous thromboembolism (VTE), including deep vein thrombosis (DVT) and pulmonary embolism, among people with severe trauma. Your provider will likely give you medications known as anticoagulants, such as heparin or warfarin, to try to prevent blood clots.
• Skincare to prevent pressure injuries (bedsores): To try to prevent pressure injuries, your healthcare team will help you rotate and reposition your body at least every two hours. They’ll keep your skin clean and dry and treat dry skin with moisturizers.
• Gastrostomy tube (G-tube) placement: Your provider may place a G-tube in your belly to reduce the risk of abdominal distension caused by paralytic ileus. A gastrostomy tube (G-tube) is a tube inserted through your belly that brings nutrition directly to your stomach. Paralytic ileus occurs when the muscle contractions that move food through your intestines are temporarily paralyzed, which is common in spinal cord injuries.
• Breathing support: If your spinal cord injury is causing issues with breathing, you may need to be on a ventilator, which is a machine that helps you breathe or breathes for you.
• Neurogenic bladder management: People with spinal cord damage, including BSS, may lose control of their bladder. A urinary catheter and other urological treatments may be required if this happens.
• Autonomic dysreflexia treatment: People with spinal cord damage may have marked fluctuations in blood pressure and other symptoms that may need careful management with blood pressure and heart medications.
• Temperature-regulating blankets: People with BSS often can’t regulate their body temperatures. Your healthcare team may provide temperature-regulating blankets to help with this.

Rehabilitation for Brown-Séquard syndrome

After initial care for Brown-Séquard syndrome (BSS), rehabilitation in the form of physical and occupational therapy should begin as soon as possible to improve and/or regain motor function.

Physical therapy goals include:

• Maintaining strength in neurologically intact muscles.
• Maintaining range of motion in joints.
• Preventing skin breakdown by proper positioning and weight shifting.
• Improving mobility.

Physical therapy involves therapies and exercises to ease pain and help you function and move. Your physical therapist will work with you to improve your mobility. They may provide devices that help you continue daily activities, such as braces, hand splits, limb supports or a wheelchair.

Occupational therapy involves therapies and exercises that help people regain independence in all areas of their lives after a physical or neurological issue. During occupational therapy for BSS, you’ll learn new techniques, with or without the use of adaptive equipment, for everyday tasks, such as hygiene and grooming, eating and putting on clothes.

Can Brown-Séquard syndrome be prevented?

The only way to prevent Brown-Séquard syndrome is to practice standard safety, such as driving and traffic safety, to try to prevent injuring your spinal cord.

What is the prognosis (outlook) of Brown-Séquard syndrome?

The prognosis (outlook) of Brown-Séquard syndrome (BSS) depends on several factors, including the cause of the spinal cord damage and how much it’s damaged.

But, overall, the prognosis of BSS is usually good. People with BSS have a fair chance of recovering some of their function, including walking. Recovery is a slow process, however. It becomes slower throughout three to six months after the onset of the syndrome, and it can take up to two years for ongoing neurological recovery.

What are the possible complications of Brown-Séquard syndrome?

Untreated Brown-Séquard syndrome may result in the following complications:

• Abdominal distension.
• Depression.
• Low blood pressure (hypotension).
• Pulmonary embolism (blood clot in your lung).
• Infections — most commonly in your lungs and urinary tract.
• Permanent paralysis.

When should I see my healthcare provider about Brown-Séquard syndrome?

If you experience sudden muscle weakness or paralysis and/or loss of sensation on one side of your body, get to the nearest emergency room as soon as possible.

If you’ve been diagnosed with Brown-Séquard syndrome, you’ll need to see your healthcare team regularly to make sure your spinal cord injury is healing properly. Be sure to go to all of your physical and occupational therapy appointments to ensure the best and quickest recovery possible.

A note from Cleveland Clinic

Brown-Séquard syndrome can be scary to experience. The good news is that many people with this condition regain or have improved motor and sensory function after several months of recovery. Know that your healthcare team will be available to help you get back on track.