Brown-Séquard syndrome is caused by hemisection of the spinal cord. Causes include penetrating trauma, tumor, disc herniation, and demyelinating disease.
In Brown-Séquard Syndrome, there is a loss of all sensation on the same side as the lesion at the level of the lesion.
In Brown-Séquard Syndrome, there is segmental flaccid paresis at the level of the lesion due to the affectation of the lower motor neurons.
Due to the Corticospinal tract damage, there is ipsilateral spastic paralysis below the level of the lesion. Clinically, this manifests as Upper Motor Neuron (UMN) signs below the level of the lesion, such as spasticity, increased muscle tone, and exaggerated deep tendon reflexes.
In Brown-Séquard Syndrome, there is a loss of proprioception, vibration, and tactile (fine touch) discrimination below the level of the lesion due to an interrupted posterior column.
In lesions above T1, Horner syndrome occurs due to damage to the ipsilateral sympathetic fibers. Remember that Horner Syndrome is characterized by the triad of miosis, partial ptosis, and facial anhidrosis. Refer to the Horner syndrome Picmonic to review it.
In Brown-Séquard syndrome, there is contralateral loss of pain, temperature, and crude touch sensation one or two levels below the lesion due to an interrupted spinothalamic tract. Remember that input of pain and temperature sensation from one side of the body (spinothalamic tract) crosses at the segmental level and runs towards the brain through the other side of the spinal cord.
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