A patient presents with spastic paralysis on the right, loss of proprioception and vibration on the right, and loss of pain and temperature on the left after spinal trauma. Dx?

A patient presents with spastic paralysis on the right, loss of proprioception and vibration on the right, and loss of pain and temperature on the left after spinal trauma. Dx?

• A. Brown-Sequard syndrome
• B. Anterior Cord Syndrome
• C. Central Cord Syndrome
• D. Posterior Cord Syndrome

Answer: (A)

A right-sided hemisection of the spinal cord produces Brown-Sequard syndrome. When one side is damaged, the corticospinal tract on that same side loses descending motor input, causing upper motor neuron signs such as spastic paralysis below the lesion on the right. The ipsilateral dorsal columns are also disrupted, leading to loss of fine touch, vibration, and proprioception on the right. Meanwhile, the spinothalamic tract crosses shortly after entry, so pain and temperature fibers from the opposite (left) side are disrupted as they ascend, producing contralateral loss of pain and temperature starting a few levels below the injury. The pattern described—right-sided motor and proprioception loss with left-sided pain/temperature loss—fits this dissociated, ipsilateral-and-contralateral presentation of Brown-Sequard syndrome. Other syndromes don’t match: anterior cord syndrome would spare vibration/proprioception and cause bilateral motor and pain/temperature loss; posterior cord syndrome would impair only proprioception/vibration with preserved motor and pain/temperature; central cord syndrome typically affects the upper extremities more than the lower with different sensory patterns.

A right-sided hemisection of the spinal cord produces Brown-Sequard syndrome. When one side is damaged, the corticospinal tract on that same side loses descending motor input, causing upper motor neuron signs such as spastic paralysis below the lesion on the right. The ipsilateral dorsal columns are also disrupted, leading to loss of fine touch, vibration, and proprioception on the right. Meanwhile, the spinothalamic tract crosses shortly after entry, so pain and temperature fibers from the opposite (left) side are disrupted as they ascend, producing contralateral loss of pain and temperature starting a few levels below the injury. The pattern described—right-sided motor and proprioception loss with left-sided pain/temperature loss—fits this dissociated, ipsilateral-and-contralateral presentation of Brown-Sequard syndrome.

Other syndromes don’t match: anterior cord syndrome would spare vibration/proprioception and cause bilateral motor and pain/temperature loss; posterior cord syndrome would impair only proprioception/vibration with preserved motor and pain/temperature; central cord syndrome typically affects the upper extremities more than the lower with different sensory patterns.