Functional recovery in Brown-Séquard plus syndrome: A case report

Abstract

Introduction: Brown-Séquard syndrome (BSS) is a rare neurological condition characterized by hemiplegia and hemianesthesia. It occurs as the sequelae to a hemi-transection of the spinal cord, and constitutes an incomplete spinal cord injury. We report a case of presumed BSS that resulted from a stab wound to the thoracic spine. Case Report: A 64-year-old male presented to Howard University Hospital with complaints of back pain and loss of left lower extremity motor function. Neurological examination revealed weakness in the L2 through S1 nerve root distributions in the left lower extremity and hypoesthesia along the L2 through S1 dermatomal distributions in the right lower extremity. Imaging disclosed a foreign body extending from the muscle layer through the T6–T7 disc space. The patient was treated operatively with removal of a knife blade; the handle of which had been broken off at the surface of the skin. Post-operatively, prior to his discharge to an acute rehabilitation center, the patient’s motor symptoms improved while his sensory symptoms worsened. He was lost to follow-up for approximately six months and returned with a debilitating spastic paraparesis. Conclusion: The presenting symptoms of BSS are not always uniform, and thus may constitute a Brown-Séquard plus syndrome (BSPS). Surgical intervention is rare; however, it may occasionally be necessary in the setting of penetrating trauma. Long-term functional recovery for BSS as documented in the literature is variable. With aggressive physical therapy and rehabilitation, a good outcome is attainable. The functional outcome of BSPS, however, may not be as favorable.