Brown-Sèquard syndrome produced by cervical disc herniation: report of two cases and review of the literature

Abstract

Background context: Brown-Sèquard syndrome is most commonly seen with spinal trauma and extramedullary spinal neoplasm. A herniated cervical disc has rarely been considered to be a cause of Brown-Sèquard syndrome.

Purpose: To report and discuss two cases of Brown-Sèquard syndrome produced by herniated cervical disc.

Study design/setting: Case studies in Japan.

Patient sample: The first patient was a 64-year-old man who presented with right leg weakness and diminished sensation to pain and temperature in the left side below the T4 dermatome. The second patient was a 39-year-old man who presented with right-sided weakness and diminished sensation to pain and temperature in the left side below the T6 dermatome.

Outcome measures: American Spinal Cord Injury Association (ASIA) impairment scale (only our cases).

Methods: These patients were diagnosed to have Brown-Sèquard syndrome produced by herniated cervical disc. Anterior cervical discectomy with fusion was performed for these patients.

Results: These cases revealed contralateral deficit in sensation of pain and temperature of more than a few levels below the cord compression, and showed paracentral protruded disc in magnetic resonance images and cervical spinal stenosis in cervical spine X-rays. Postoperatively, motor and sensory function of these patients returned to normal.

Conclusions: Characteristic finding in discogenic Brown-Sèquard syndrome are contralateral deficit in sensation of pain and temperature of more below than a few levels below the cord compression and paracentral protruded disc with cervical spinal stenosis. Outcomes are favorable in rapid diagnosis by magnetic resonance images and performance of anterior approach.