Brown-Sequard's syndrome is characterized by
Ans. a (Loss of temperature & pain on opposite side). (Ref. Harrison 18th/Ch. 377)BROWN-SEQUARD HEMICORD SYNDROME consists of -# Ipsilateral weakness (corticospinal tract) and# Loss of joint position and vibratory sense (posterior column), with# Contralateral loss of pain and temperature sense (spinothalamic tract) one or two levels below the lesion. Brown-Sequard Hemlcord SyndromeThis consists of ipsilateral weakness (corticospinal tract) and loss of joint position and vibratory sense (posterior column), with contralateral loss of pain and temperature sense (spinothalamic tract) one or two levels below the lesion. Segmental signs, such as radicular pain, muscle atrophy, or loss of a deep tendon reflex, are unilateral. Partial forms are more common than the fully developed syndrome.Central Cord SyndromeThis syndrome results from selective damage to the grey matter nerve cells and crossing spinothalamic tracts surrounding the central canal. In the cervical cord, the central cord syndrome produces arm weakness out of proportion to leg weakness and a "dissociated" sensory loss, meaning loss of pain and temperature sensations over the shoulders, lower neck, and upper trunk (cape distribution), in contrast to preservation of light touch, joint position, and vibration sense in these regions. Spinal trauma, syringomyelia, and intrinsic cord tumors are the main causes.Anterior Spinal Artery SyndromeInfarction of the cord is generally the result of occlusion or diminished flow in this artery. The result is extensive bilateral tissue destruction that spares the posterior columns. All spinal cord functions motor, sensory, and autonomic are lost below the level of the lesion, with the striking exception of retained vibration and position sensation.Foramen Magnum SyndromeLesions in this area interrupt decussating pyramidal tract fibers destined for the legs, which cross caudal to those of the arms, resulting in weakness of the legs (crural paresis). Compressive lesions near the foramen magnum may produce weakness of the ipsilateral shoulder and arm followed by weakness of the ipsilateral leg, then the contralateral leg, and finally the contralateral arm, an "around-the-clock" pattern that may begin in any of the four limbs. There is typically suboccipital pain spreading to the neck and shoulders.Intramedullary and Extramedullary SyndromesIt is useful to differentiate intramedullary processes, arising within the substance of the cord, from extramedullary ones that compress the spinal cord or its vascular supply. The differentiating features are only relative and serve as clinical guides. With extramedullary lesions, radicular pain is often prominent, and there is early sacral sensory loss (lateral spinothalamic tract) and spastic weakness in the legs (corticospinal tract) due to the superficial location of leg fibers in the corticospinal tract. Intramedullary lesions tend to produce poorly localized burning pain rather than radicular pain and to spare sensation in the perineal and sacral areas ("sacral sparing"), reflecting the laminated configuration of the spinothalamic tract with sacral fibers outermost; corticospinal tract signs appear later. Regarding extramedullary lesions, a further distinction is made between extradural and intradural masses, as the former are generally malignant and the latter benign (neurofibroma being a common cause). Consequently, a long duration of symptoms favors an intradural origin.
Loss of temperature & pain on opposite side
Loss of touch on opposite side
Loss of motor power on opposite side
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C.N.S.