Korean J Neurotrauma.  2019 Oct;15(2):204-208. 10.13004/kjnt.2019.15.e21.

Brown-Séquard Syndrome Caused by Acute Traumatic Cervical Disc Herniation

• Kim SJ
• Lee SH
• Bae J
• Shin SH

• KMID: 2461129
• DOI: http://doi.org/10.13004/kjnt.2019.15.e21

Abstract

Brown-Séquard syndrome (BSS) is an incomplete spinal cord injury caused by damage to one-half of the spinal cord. Most cases of BSS result from penetrating trauma or tumors, and acute cervical disc herniation is a relatively rare cause of BSS. In this case, a 34-year-old man with a sudden onset posterior neck pain and left side motor weakness was admitted to the local spine hospital. Pain and temperature sensation of pain was decreased below the right C4 dermatome. The left arm and leg motor grade was 0. Magnetic resonance imaging (MRI) showed a huge trans-ligamentous herniated disc rupture from the center to the left at the level of C3-4, and anterior cervical discectomy and fusion were performed. After emergency surgery, left arm and leg motor grade recovered to 2, and normal voiding function returned. MRI verified complete removal of the cervical herniated disc. This case describes the approach to rapid diagnosis in a patient with characteristic clinical symptoms of BSS and radiological findings of a herniated cervical disc. Rapid and accurate diagnosis and immediate decompressive surgery increased the possibility of a good surgical outcome, even if the neurologic deficits are grave at the time of admission.

Keyword

Brown-Sequard syndrome; Herniated disc; Anterior cervical discectomy and fusion

MeSH Terms

Adult
Arm
Brown-Sequard Syndrome
Diagnosis
Diskectomy
Emergencies
Humans
Intervertebral Disc Displacement
Leg
Magnetic Resonance Imaging
Neck Pain
Neurologic Manifestations
Rupture
Sensation
Spinal Cord
Spinal Cord Injuries
Spine

Figure

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  FIGURE 1 Preoperative cervical MRI. Sagittal (A) MRI shows a herniated disc at the C3–4 level. Axial (B) MRI shows a huge transligamentous disc rupture from the center to the left at the C3–4 level. Findings indicating contusion were also observed.MRI: magnetic resonance imaging.

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  FIGURE 2 Postoperative cervical MRI. Sagittal (A) and axial (B) MRI shows a properly inserted cage and complete removal of the disc at C3–4. Signal changes persist in the left spinal cord.MRI: magnetic resonance imaging.

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  FIGURE 3 Cervical X-ray images 6 months after surgery. Cervical anteroposterior (A) and lateral (B) X-ray images show a well-maintained cage at the C3–4 level.

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  FIGURE 4 Cervical MRI 6 months after surgery. Sagittal (A) and axial (B) MRI shows fusion of C3–4 and decreased signal change in the spinal cord at C3–4.MRI: magnetic resonance imaging.

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