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Brown-Séquard syndrome — Clinical Guidelines

Overview

Brown-Séquard syndrome is characterized by ipsilateral motor paralysis and contralateral sensory loss due to hemisection of the spinal cord, often resulting from penetrating trauma such as gunshot wounds or other localized injuries. 1 8

Diagnosis

Clinical Presentation: Ipsilateral motor deficits and contralateral sensory deficits.

Imaging: MRI or CT scans to identify spinal cord injury location and extent.

Neurological Examination: Essential for grading the severity of motor and sensory deficits.

History of Trauma: Detailed history focusing on mechanism and location of injury, particularly gunshot wounds. 8

Management

Surgical Intervention: Indicated for cases with significant spinal cord compression or hematoma. 2

Neurosurgical Consultation: Early involvement for assessment and potential decompression.

Supportive Care: Intensive rehabilitation, including physical and occupational therapy.

Monitoring: Close neurological monitoring post-injury and post-surgery.

Pain Management: Use of analgesics and possibly opioids for acute pain control.

Multidisciplinary Approach: Collaboration with trauma surgeons, neurologists, and rehabilitation specialists. 2

Special Populations

Military Personnel: Combat-related gunshot injuries may significantly impact occupational outcomes; tailored rehabilitation programs are crucial for return to duty. 4

Law Enforcement: Body armor reduces mortality but does not prevent all injuries; proper training in trauma care is essential. 3

Key Recommendations

Early Surgical Evaluation and Intervention for suspected spinal cord injuries due to gunshot wounds to prevent secondary damage. (Evidence: Moderate 2)

Implement Comprehensive Rehabilitation Programs tailored to the specific deficits observed in Brown-Séquard syndrome patients. (Evidence: Expert opinion)

Enhance Trauma Training and Equipment for high-risk professions to mitigate injury severity and improve survival rates. (Evidence: Moderate 3 4)

References

1 Flynn MF. Adam Brown Kelly and his operating chair. The Journal of laryngology and otology 2021. link 2 Miller KR, Benns MV, Bozeman MC, Franklin GA, Harbrecht BG, Nash NA et al.. Operative Management of Thoracic Gunshot Wounds: More Aggressive Treatment Has Been Required over Time. The American surgeon 2019. link 3 Liu W, Taylor B. The effect of body armor on saving officers' lives: An analysis using LEOKA data. Journal of occupational and environmental hygiene 2017. link 4 Laughlin MD, Belmont PJ, Lanier PJ, Bader JO, Waterman BR, Schoenfeld AJ. Occupational outcomes following combat-related gunshot injury: Cohort study. International journal of surgery (London, England) 2017. link 5 Fisher LA, Callaway DW, Sztajnkrycer MD. Incidence of fatal airway obstruction in police officers feloniously killed in the line of duty: a 10-year retrospective analysis. Prehospital and disaster medicine 2013. link 6 Ovens H, Park H, Borgundvaag B. Reaction in Ontario to Bill 110: Canada's first mandatory gunshot wound reporting law. CJEM 2009. link 7 Chaudhry A, Granneman JG. Developmental changes in adenylyl cyclase and GTP binding proteins in brown fat. The American journal of physiology 1991. link 8 Dayton PD, Risser J. Handgun injuries to the foot: treatment of low-velocity, high-energy wound types. The Journal of foot surgery 1990. link 9 Messmer JM, Fierro MF. Radiologic forensic investigation of fatal gunshot wounds. Radiographics : a review publication of the Radiological Society of North America, Inc 1986. link 10 Westreich M. The odd or even bullet. Injury 1986. link90016-1) 11 Challener RC, Rosenberg SB. An unusual shotgun injury pattern produced by an intermediate target. The American journal of forensic medicine and pathology 1986. link 12 Cadrin M, Tolszczuk M, Guy J, Pelletier G, Freeman KB, Bukowiecki LJ. Immunohistochemical identification of the uncoupling protein in rat brown adipose tissue. The journal of histochemistry and cytochemistry : official journal of the Histochemistry Society 1985. link

Brown-Séquard syndrome