Brown-Séquard Syndrome: Diagnosis, Symptoms, and Testing

Clinical Presentation

Brown-Séquard syndrome results from hemisection of the spinal cord, producing an ipsilateral motor/proprioception deficit and contralateral pain/temperature loss below the lesion.

Diagnostic Approach

1. History – Trauma (penetrating), disc herniation, tumor, MS, ischemia.
2. Neurological Exam:
   • Ipsilateral: weakness, spasticity, loss of vibration/position sense.
   • Contralateral: loss of pain/temperature (starts 1–2 levels below).
   • Ipsilateral facial sensory loss possible if above C3.
3. Imaging – MRI (gold standard) visualizes cord lesion, compression, edema. CT myelogram if MRI contraindicated.
4. Additional Tests – Lumbar puncture if inflammatory/infectious cause suspected.

Prognosis

Depends on etiology and severity. Incomplete lesions often have good functional recovery with rehabilitation.