Brown–Séquard-plus syndrome due to stab injury: a case report

Abstract

Study Design: Case report. Objective: To describe the mechanism of injury in this case and its clinical features. Magnetic resonance (MR) images of hemorrhage in spinal cord injury due to stab wound are discussed. Methods: We describe the case of a 21-year-old woman who was stabbed in the right side of her neck and developed left-sided Brown-Se´quard syndrome plus loss of bilateral proprioceptive sensation. Neither plain radiographs nor computed tomography of the cervical spine demonstrated any foreign bodies or fractures of the cervical spine. T2-weighted cervical MR images confirm spinal cord hemiresection at C5-C6. Results: MR imaging was performed serially at 4 days, 4 weeks, and 8 weeks after trauma. The signal pattern of the spinal cord at the site of injury varied iso, iso, and low on T1-weighted consecutive images. Meanwhile, high signal intensity on T2-weighted images was consistent during the 8 weeks after incidence of trauma. A T2-weighted sagittal image showed a tiny spot of low intensity in the high signal band at the site of penetration, demonstrating hemosiderin formation in the spinal cord. The patient was treated conservatively and, recovered from Frankel grade C to grade D. Conclusion: Spinal cord injuries (SCI) following stab wounds are rare. MR imaging is definitely useful for recording and monitoring the pathology of SCI.

Diffusion tensor tractography demonstration of partially injured spinal cord tracts in a patient with posttraumatic brown sequard syndrome

“…However, MRI does not clearly show the extent of interruption to the spinal cord tracts. Although the clinical presentation and the severity of the syndrome vary, the MRI findings are relatively same (8,9). However, in this report, we have shown that diffusion tensor tractography clearly demonstrates the interruption of long spinal cord tracts at the site of injury and the extent of transection of the spinal cord is depicted clearly.…”

An unusual stab wound causing a traumatic pseudomeningocele at the craniocervical junction

“…Clearly identified indications for immediate exploration are a retained foreign body, a persistent CSF leak, radiologic signs of extrinsic cord compression such as by hematoma, and sepsis due to the delayed development of an epidural abscess or granuloma. 2,3,8 The skin wound may be missed easily, as it is often small and not situated directly over the craniocervical junction. Therefore, it is important to correctly identify such a wound and to be aware of the associated symptoms.…”

“…The most commonly reported site for a stab wound is in the thoracic spine, followed by the cervical spine and the lumbar spine. [1][2][3] Reports of stab injuries at the craniocervical junction are rare. [4][5][6] Because of the anatomy of this area, the penetrating weapon is deflected by the occipital squama into the atlanto-occipital or atlantoaxial interspace in the craniocervical junction.…”

“…[1][2][3][4][5][6][7] Most of these cysts are due to blunt head trauma in childhood prior to the age of three. A dural tear and fracture of the inner table are probably important factors, causing pulsation of the brain through the torn dura.…”

The role of MRI in spinal stab wounds compared with intraoperative findings

“…In the US, spinal cord injuries (SCIs) make up only 2.6% [2] of all the trauma cases, of which fewer than 1.5% [3][4][5] can be attributed to stab wounds. The most reported site is the thoracic spine, followed by the cervical and the lumbar spine [3,6,7]. The craniocervical junction is rarely affected due to the anatomy of this region [8][9][10].…”