Brachial plexus-avulsion causing Brown-Séquard syndrome

Abstract

We describe three patients with pre-ganglionic (avulsion) injuries of the brachial plexus which caused a partial Brown-Séquard syndrome.

Concomitant Traumatic Spinal Cord and Brachial Plexus Injuries in Adult Patients

“…I n our study, the prevalence of concomitant spinal cord injury in adult patients with a closed-traction brachial plexus injury was 12.2%, which is significantly higher than what has been previously reported 1,3,[5][6][7][8]17,18 . Concomitant spinal cord injury in patients with brachial plexus injury is theorized to occur directly from the traumatic event.…”

“…avulsions have been reported to cause Brown-Séquard syndrome, with a prevalence of 2% to 5% in patients with brachial plexus injuries [6][7][8] . Direct injury to the spinal cord from the traumatic event or indirect injuries due to nerve root avulsions or intradural nerve root ruptures have been implicated as the cause of these combined injuries 1,3,[9][10][11] .…”

“…Intradural ruptures (rootlet rupture proximal to the dorsal root ganglion) or central avulsions (rootlet and central nervous tissue avulsed from the spinal cord) 8,21,22 can result in anterior horn cell death 6 . Central avulsions intrinsically cause spinal cord damage; this is evidenced by signal intensity changes within the spinal cord on MRI in up to 20% of patients with brachial plexus injury 23 and by MRI findings of spinal cord hemorrhage, scarring, edema, and/or posttraumatic syrinx in preganglionic injuries 24,25 .…”

“…However, in the patient with a brachial plexus injury and a concomitant spinal cord injury, the lesion to the spinal cord may contribute to poor surgical results, depending on the surgical strategy. For example, the results of intercostal nerve transfers are extremely poor in patients with Brown-Séquard syndrome 6 . We postulate that the spasticity associated with the upper motor-neuron lesion could result in compromised target sensorimotor function.…”

Current Concepts of the Treatment of Adult Brachial Plexus Injuries

“…Finally, examination for potential spinal cord injury is necessary, as there is a 2%-5% incidence of spinal cord injury with brachial plexus injuries. 3,4 in the workup of the patient to rule out coexistent fractures of the spine, ribs, clavicle, scapula, or bones within the affected extremity. Inspiratory-expiratory chest films, ultrasound of the diaphragm, or fluoroscopy provides information regarding the phrenic nerve function and potential injury to the C5 nerve root, as the phrenic nerve receives contributions from C3 thru C5.…”