- Department of Neurosurgery, Riverside University Health System, Riverside, California, USA
Department of Neurosurgery, Riverside University Health System, Riverside, California, USA
DOI:10.4103/sni.sni_142_18Copyright: © 2018 Surgical Neurology International This is an open access journal, and articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms.
How to cite this article: Samir Kashyap, Gohar Majeed, Shokry Lawandy. A rare case of Brown-Sequard syndrome caused by traumatic cervical epidural hematoma. 23-Oct-2018;9:213
How to cite this URL: Samir Kashyap, Gohar Majeed, Shokry Lawandy. A rare case of Brown-Sequard syndrome caused by traumatic cervical epidural hematoma. 23-Oct-2018;9:213. Available from: http://surgicalneurologyint.com/surgicalint-articles/9048/
Background:Brown-Sequard syndrome (BSS) is a well-known entity that is most commonly caused by a penetrating injury to the spinal cord (e.g., stab wound or gunshot wound). It is characterized by an ipsilateral weakness (damage to corticospinal tracts) and contralateral loss of pain and temperature two levels below the lesion (damage to lateral spinothalamic tracts). Although, rarely non-penetrating injuries, tumors, disc herniations, infections, autoimmune diseases, and epidural hematomas (non-penetrating trauma and spontaneous) have contributed to BSS syndromes, there are only four cases of BSS in the literature attributed to traumatic spinal epidural hematomas. Here, we add an additional case involving a 59-year-old male.
Case Description:A 59-year-old male presented with a Brown-Sequard syndrome (BSS) after a motor vehicle accident. The magnetic resonance imaging (MRI) demonstrated a cervical epidural hematoma at the C7–T1 level. Following a T1 laminectomy and C6–T1 fusion, his neurological deficit markedly improved. Within six postoperative months, he regained full motor function.
Conclusion:For this patient and others with a traumatic cervical epidural hematoma (C7T1) resulting in a BSS, early decompression (within 48 hours) should result in marked postoperative neurological improvement.
Keywords: Brown-Sequard, cervical epidural hematoma, spinal trauma
Brown-Sequard syndrome (BSS) is a well-known entity that is most commonly caused by a penetrating injury to the spinal cord (e.g., stab wound or gunshot wound).First described in 1850, it is characterized by ipsilateral weakness (damage to corticospinal tracts) and contralateral loss of pain and temperature (e.g., two levels below the lesion reflecting damage to lateral spinothalamic tracts).[
A 59-year-old Caucasian male was involved in a rollover motor vehicle accident. He was immediately reported to have paresthesias in the both upper extremities accompanied by profound weakness in his left lower extremity.
Upon arrival to the Emergency Department, his Glasgow Coma Score was 15, but he was complaining of severe cervicothoracic midline tenderness. The motor examination revealed a left hemiparesis (4/5 in distal upper extremity and 2/5 lower extremity) with no right-sided weakness. The sensory examination demonstrated allodynia at the right C7 dermatome, and diminished light touch and pinprick sensation below T1. Rectal tone was present. There was no hyperreflexia or clonus, but he had bilateral Babinski signs.
The initial CT of the cervical spine showed multiple areas of chronic degenerative changes without any fractures. However, the STAT MRI revealed a left paramedian dorsal epidural hematoma at the C7–T1 level causing cord compression along with complete disruption of the ligamentum flavum and C7T1 interspinous ligament [
The patient taken to the operating room emergently for a T1 laminectomy, evacuation of the C7T1 epidural hematoma, and a C6–T1 instrumented fusion [
BSS secondary to a spinal epidural hematomas (SEDH) are extremely rare. In a meta-analysis conducted by Kreppel et al.[
The incidence of spontaneous SEDH is rare, reported in 0.1 per 100,000 people.[
In the setting of high-impact trauma, such as that experienced by our patient; development of a SEDH at the lower cervical levels was likely related to the rotatory/whiplash mechanism of injury most pronounced at these levels. Some controversy exists regarding whether the etiology of bleeding is arterial or venous in this condition.
There are a number of surgical approaches to posterior cervicothoracic epidural hematomas such as laminectomy, hemilaminectomy, and laminoplasty. Alternatively, for a symptomatic anterior SEDH, a direct approach such as a discectomy or corpectomy would likely be utilized.
We believe that urgent surgical decompression and evacuation of the hematoma played a vital role in our patient's neurological recovery. Yoon et al.[
Penetrating spinal trauma rarely results in a BSS attributed to a posterior cervicothoracic epidural hematoma. Immediate surgical management should be pursued if the patient has a significant neurological deficit (e.g., incomplete spinal cord injury) to avoid further irreversible symptoms progression.
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