Brown–Sequard syndrome produced by cervical disc herniation with complete neurologic recovery: report of three cases and review of the literature

Abstract

Study design: Case report. Objective: To report three cases of Brown-Sequard syndrome (BSS) associated with cervical disc herniation. Method: We describe clinical and radiographic review of three patients who presented with BSS caused by cervical disc herniation. Three patients presented with ipsilateral motor weakness and diminished sensation to pain and temperature on the contralateral side. Magnetic resonance images of the cervical spine in all cases, showed a large paramedian disc herniation at C5-C6, with ipsilateral severe spinal cord compression. Microsurgical removal of the herniated disc via anterior foraminotomy was performed and complete decompression of the spinal cord was achieved. Results: Postoperatively, the neurological symptoms recovered rapidly with a complete remission of their symptoms. Conclusion: Although BSS is rarely associated with degenerative cervical spine disease, cervical disc herniation should be kept in mind and prompt evaluation is indicated. Anterior foraminotomy suffices for spinal cord decompression with improvement of the neurological function.

Cervical Intradural Disc Herniation After Spinal Manipulation Therapy in a Patient With Ossification of Posterior Longitudinal Ligament

“…However, the prognosis is favorable in most cases. 11 MRI can indicate intradural disc herniation as abrupt discontinuity of the PLL and the "hawk-beak sign," 12 which was the case in our patient ( Figure 1A, B). It is likely that the enhancement depends on the age of the intradural disc herniation.…”

Management of brown-sequard syndrome in cervical disc diseases

“…Complete or typical picture of Brown-Sequard syndrome is a rare finding (13,14) and all our cases presented with incomplete Brown-Sequard syndrome (5/7) as there was no loss of deep sensation in any of them. This can be explained by presence of anterior compression which leads to affection In our cases we reported history of neck pain with or without brachialgia due to cervical disc disease in 6/7 of our patients before the onset of motor weakness that had been precipitated by mild unexpected or unnoticed trauma.…”

“…These patients may present with neck pain, cervical radiculopathy, myelopathy or radiculomyelopathy. Although the herniated disc usually produces symptoms in the ipsilateral side (28), there are rare reported cases with contralateral symptoms in the form of complete or incomplete Brown-Sequard syndrome (2, 14,16,20,28). This is a rare neurological entity due to spinal cord compression leading to loss of motor function, deep sensation and crude touch on one side of the body due to compression of the corticospinal tract, gracile and cuneate tract respectively.…”

Cervical Disc Herniation Producing Acute Brown-Sequard Syndrome

“…The most frequent causes of this syndrome are traumatic injuries to the spinal cord and spinal cord tumors (metastatic or intrinsic) 2,14,15,17) . In addition, it has been reported in patients with various spinal pathologies, including ischemia, epidural hematoma, inflammatory causes including multiple sclerosis, and degenerative disease such as disc herniation and cervical spondylosis 11,12,20,21) . In particular, a herniated cervical disc has been rarely reported as a cause of this syndrome 1,7,8,13,18) .…”