Is one side of your body numb and the other side numb? Could it be Brown-Séquard Syndrome?

Have you ever heard of a strange condition where you can't move one side of your body and feel nothing on the other? It can happen after an accident. It's a bit scary, but today we're going to talk about a condition that can happen at just the right time, but it's not very common, called Brown-Séquard Syndrome . Don't worry, let's talk about it simply.

What is Brown-Séquard Syndrome, this strangely named disease?

Simply put, Brown-Séquard syndrome (BSS) is a very rare neurological condition. It occurs when there is damage to your spinal cord , but the damage is limited to just one side of the spinal cord. Think of it like your spinal cord, which is like a cable that carries messages from your brain throughout your body and then relays information from your body back to your brain. So this problem only occurs when there is damage to just one side of this cable.

What happens is that on the same side of the spinal cord that was damaged, there is weakness or paralysis of the muscles below the level of the damage. This means that you can't move that side. But, surprisingly, the sensation of pain and temperature is lost on the other side , but below the level of the damage. Sounds a bit complicated, right? Let's explain more.

Your spinal cord is a cylindrical structure that runs from the brainstem all the way down to the base of your spine. It's very delicate. It's made up of many nerve fibers. It's a major part of our nervous system.

Brown-Séquard syndrome is considered an incomplete spinal cord injury (SCI) . This means that there is some loss of sensation, motor function, or both below the injury site. In a complete SCI, there is no sensation or movement below the injury site.

It is named after the scientist Charles-Edouard Brown-Sequard, who first described the condition in 1849.

How is this different from Central Cord Syndrome?

You may have also heard of Central Cord Syndrome (CCS) . Although both are incomplete spinal cord injuries, they are two different conditions.

CCS is an incomplete injury to the middle of the spinal cord, usually in the neck. This causes weakness in the arms more than the legs.

However, in BSS , damage to any part of the spinal cord on one side causes paralysis on the affected side, while the other side loses sensation. Do you understand the difference?

Who can develop this condition? How common is it?

Brown-Sequard syndrome can affect anyone. However, it is a very rare condition . It can affect both men and women.

In the United States alone, there are about 12,000 new cases of spinal cord injury reported each year. Of these, BSS accounts for only 2% to 4%. This means that in Sri Lanka, the rate may be even lower.

What are the symptoms of Brown-Séquard syndrome (BSS)?

Symptoms of BSS usually begin after damage to one side of the spinal cord.

The first symptoms to appear are:

• Inability to move the limb below the injury (loss of muscle movement) on the same side of the spinal cord injury. This can start as weakness and progress to paralysis.
• On the other hand, there is a loss of pain and temperature sensation below the level of the injury.

Think of it this way. If someone has BSS, which is a spinal cord injury to the right side of their spine, they will not be able to move their right side, that is, from the middle of their spine down – their right hip, leg, and foot. However, on the left side, from the middle of their spine down, they will lose pain and feel heat/cold, but they will be able to move their left side. The head, neck, shoulders, and arms will function normally, unaffected by this injury.

In addition, BSS can cause symptoms such as:

• Inability to control urine and stool (urinary and fecal incontinence).
• Muscle weakness and wasting (muscle atrophy) in the affected area.

The symptoms of BSS can be very mild for some people, and very severe for others. However, with proper treatment, these symptoms gradually improve .

Does this hurt?

If the cause of BSS is a traumatic event such as a gunshot wound or a car accident, then the accident will definitely cause pain. However, due to the syndrome itself, that is, the damage to the spinal cord, there may be no pain.

However, some people with BSS may experience abnormal sensations (dysesthesia) due to spinal cord damage, which can be a burning, prickling, or tingling sensation.

What are the main causes of Brown-Séquard syndrome (BSS)?

The most common causes of BSS are injuries to the spinal cord:

• Gunshots.
• Stabbing.
• Car accidents.
• Blunt trauma.
• Spinal fractures from an accident such as a fall.

If you have an accident like this, it is very important to go to the nearest hospital as soon as possible and seek immediate medical attention.

In addition to this, BSS can also occur due to non-accidental causes, but they are somewhat less common:

• Cervical spondylosis.
• Decompression sickness is a condition that occurs after being exposed to excessive pressure underwater.
• Slipped disc in the spine (herniated disc).
• Infections such as meningitis.
• Multiple Sclerosis (MS).
• Radiation exposure.
• Blockage of a blood vessel supplying the spinal cord (spinal ischemia).
• Spinal tumors.
• Transverse myelitis.
• Tuberculosis.

How do doctors diagnose this? (Diagnosis)

If your doctor suspects you have BSS, he or she will do the following:

• Does a complete physical examination .
• A neurological exam is performed that examines movement and sensation in detail.
• They will ask about your medical history, neurological problems, and any accidents you have had.

Then, they will order several tests, such as an MRI scan , to confirm the diagnosis and to check for other causes.

What tests are being done for this?

If BSS is suspected, your doctor may order tests such as:

• MRI scan (Magnetic Resonance Imaging): This is a painless test. It uses a large magnet, radio waves, and a computer to make very clear pictures of organs and structures inside the body. MRI is very useful for BSS because it can help identify structural damage to the spine and help find the cause of BSS that occurs without an accident.
• Myelogram and CT scan (Computed Tomography): If you can’t have an MRI, your doctor may order a myelogram and then a CT scan of your spine. These tests can look for damage to the nerve tissue on one side of your spinal cord. A myelogram is an imaging test that examines the connections between your spine, discs, spinal cord, nerves, and nerve roots. A CT scan uses X-rays and computers to make detailed pictures of the inside of your body.
• Blood tests: If the cause of BSS is unclear, your doctor may order several blood tests to check for infections that could be causing the condition.
• Lumbar puncture / Spinal tap: If multiple sclerosis (MS) , transverse myelitis, or tuberculosis are suspected to be the cause of BSS, your doctor may perform a lumbar puncture to take a sample of cerebrospinal fluid (CSF) . CSF is the clear fluid that surrounds your spinal cord and brain.

What are the treatments for Brown-Séquard syndrome (BSS)?

Treatment for BSS depends on the underlying cause of the spinal cord damage.

In general, the goals of BSS treatment are:

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

A person who has BSS from a sharp weapon injury, such as a knife stab wound, will need to be treated for bleeding and tissue damage. Additionally, people who have other injuries from the accident that caused BSS will need additional treatment for those injuries as well.

There are two main phases of BSS treatment: initial treatment and rehabilitation .

Initial Treatment

Initial treatments for BSS may include:

• Surgery: In cases where BSS occurs without an accident, it is usually due to mechanical compression or herniation of the spinal cord. Surgery is required to relieve this compression.
• Blood clot-preventing medications: People with spinal cord injuries are at increased risk of developing blood clots in the veins (Venous Thromboembolism - VTE) . This includes things like deep vein thrombosis (DVT) and pulmonary embolism . Your doctor may give you medications called anticoagulants , such as heparin or warfarin, to prevent blood clots.
• Protecting the skin (to prevent bedsores): To prevent pressure injuries/bedsores, your medical team will help you turn and change positions at least every two hours. They will help keep your skin clean and dry, and apply moisturizer to dry skin.
• Gastrostomy tube (G-tube): To reduce the risk of stomach bloating due to paralytic ileus, your doctor may place a G-tube in your stomach. A G-tube is a tube that delivers nutrition directly from the stomach to the stomach. Paralytic ileus is a temporary loss of muscle contractions that move food through the intestines. This is common in spinal cord injuries.
• Respiratory support: If you have difficulty breathing due to your spinal cord injury, you may need to be connected to a ventilator . This is a machine that helps you breathe, or breathes for you.
• Neurogenic bladder management: People with spinal cord injuries, including BSS, may lose bladder control. If this happens, a urinary catheter and other urinary system-related treatments may be needed.
• Autonomic dysreflexia treatment: People with spinal cord injuries may experience significant changes in blood pressure and other symptoms. This should be treated carefully with medications that control blood pressure and heart rate.
• Temperature-regulating blankets: People with BSS often have difficulty regulating their body temperature. The medical team may provide temperature-regulating blankets to help with this.

Rehabilitation

After initial treatment for BSS, rehabilitation, such as physical therapy and occupational therapy , should begin as soon as possible to improve and/or regain mobility.

Goals of physical therapy:

• Maintaining muscle strength with good nerve function.
• Maintaining range of motion in joints.
• Prevent skin breakdown through proper posture and weight shifting.
• Improving mobility .

Physical therapy involves exercises and treatments that help you reduce pain and get you back to normal functioning and mobility. Your physical therapist will work with you to improve your mobility. They may provide you with devices to help you do everyday tasks, such as braces, hand splints, limb supports, or a wheelchair.

Occupational therapy involves treatments and exercises that help you regain independence in all aspects of your life after a physical or neurological problem. When you receive occupational therapy for BSS, you will learn new ways to do everyday tasks, such as cleaning yourself, eating, and getting dressed, with or without assistive devices.

Can this be prevented from happening?

The only way to prevent Brown-Séquard syndrome is to follow standard safety precautions to avoid damaging your spinal cord. For example, be careful when driving and walking on the road.

What are the chances of recovery from this condition? (Prognosis)

The outlook for recovery from BSS depends on several factors, including the cause of the spinal cord damage and the extent of the damage.

However, overall, the recovery rate from BSS is generally good . People with BSS have a good chance of regaining some of their function, including walking. However, recovery is a slow process . Recovery is somewhat slower, lasting three to six months from the onset of the syndrome, and it can take up to two years for the nerves to fully recover.

What complications can occur if left untreated?

If Brown-Séquard syndrome is left untreated, complications such as:

• Abdominal distension.
• Depression.
• Low blood pressure (Hypotension).
• Pulmonary embolism.
• Infections – mostly in the lungs and urinary tract.
• Permanent paralysis.

What are the best times to see a doctor?

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

If you have been diagnosed with Brown-Séquard syndrome, you should see your medical team regularly to make sure your spinal cord injury is healing properly. Be sure to keep your physical therapy and occupational therapy appointments to help you recover as well and quickly as possible.

The most important thing to remember (Take-Home Message)

Brown-Séquard syndrome can be a bit scary to hear. But the good news is that many people with this condition regain or improve their motor and sensory abilities after a few months of recovery. Remember, your medical team will always be there to help you get back on track. So stay strong and follow the advice given.

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