Spinal cord injury without radiological abnormality (SCIWORA) manifested as self-limited brown-SEQUARD syndrome

Abstract

IntroductionCombination between SCIWORA and Brown-Sequard syndrome in a patient is a rare condition. In SCIWORA, there is usually a delay in neurologic deficits which can potentially lead to misdiagnosis. Therefore, the clinician should have a good understanding of the course of the disease to make a good diagnosis and treatment.Case reportReporting a case of female 20 years old with chief complaint of severe neck pain and delayed limbs weakness. The mechanism of injury was fall with the head hit the ground in left lateral flexion position. The physical examination showed zero motor power of the right limbs and contralateral pain and temperature deficit 1 h after the injury. We diagnosed the patient with incomplete spinal cord injury at C4 level with associated Brown-Sequard syndrome. We gave soft collar neck for immobilization, medication with NSAID for analgetic and Methylprednisolon. We found dramatic improvement in 10 h after the injury with motor improvement from 0 to 5 and normal sensory function. The patient then was discharged with good functional outcome and with no sequelae.ConclusionIncomplete cervical spinal cord injury without radiological abnormality that manifested as Brown-Sequard syndrome is a rare case and potentially confusing condition. Better understanding of the course of the disease may help the clinician to make a right diagnosis and plan for management.

Spinal cord injury without radiographic abnormalities caused by rotation-stretching injury manifesting as Brown-Sequard syndrome: a case report

“…The case of a young woman has been reported who fell and hit her head on the ground first in the left lateral flexion position, and her symptoms manifested as BSS. 8 In our case, the patient's clothing was caught in a rapid autorotation machine, causing the body to rotate axially. This powerful twisting force caused the thoracic spinal cord to be rotation-stretched rather than stretching along the long axis of the spinal cord.…”

Conservative Management of Traumatic Brown-Séquard Syndrome: A Case Report

“…Further complications, such as wound infection, meningitis, and sepsis should be treated accordingly [ 16 ]. However, Sakti et al [ 17 ] reported treating BSS associated with spinal cord injury without radiological abnormalities conservatively with a cervical collar, with dramatic improvements occurring within hours [ 17 ].…”

Pediatric SCIWORA-Type Injuries Revisited: What Should be the Most Discerning Definition of SCIWORA at the Current Days?

“…Since the negative impact of Central Nervous System (CNS) injuries on somatic growth in children is well established [24], even mild neurological sequelae suffered at a young age will have repercussions on orthopaedic development in the medium to long term [25], especially progressive neuromuscular scoliosis [26]. Second, the possibility of the development of intraspinal tissue damage resulting from the development of gliosis and/or syringomyelia [27] leading to unexpected and unexplained long-term neurological impairment, even in the case of only transient or mild initial neurological signs and symptoms have been addressed both among pediatric [28,29] and adult population [30]. Syringomyelia is recognized as the main factor of neurological deterioration following SCI, since MRI has improved the diagnosis, but the correlation between the severity of SCI and the incidence of Post-Traumatic Syringomyelia (PTS) or the time interval to its onset is controversial [30].…”