Brown-Sequard syndrome after blunt cervical spine trauma: clinical and radiological correlations

Abstract

The objective of this study was to describe clinical and radiological features of a series of patients presenting with Brown-Sequard syndrome after blunt spinal trauma and to determine whether a correlation exists between cervical plain films, CT, MRI and the clinical presentation and neurological outcome. A retrospective review was done of the medical records and analysis of clinical and radiological features of patients diagnosed of BSS after blunt cervical spine trauma and admitted to our hospital between 1995 and 2005. Ten patients were collected for study, three with upper- and seven with lower-cervical spine fracture. ASIA impairment scale and motor score were determined on admission and at last follow-up (6 months-9 years, mean 30 months). Patients with lower cervical spine fracture presented with laminar fracture ipsilateral to the side of cord injury in five out of six cases. T2-weighted hyperintensity was present in seven patients showing a close correlation with neurological deficit in terms of side and level but not with the severity of motor deficit. Patients with Brown-Sequard syndrome secondary to blunt cervical spine injury commonly presented T2-weighted hyperintensity in the clinically affected hemicord. A close correlation was observed between these signal changes in the MR studies and the neurologic level. Effacement of the anterior cervical subarachnoid space was present in all patients, standing as a highly sensitive but very nonspecific finding. In the present study, craniocaudal extent of T2-weighted hyperintensity of the cord failed to demonstrate a positive correlation with neurological impairment.

Fig. 1

Images corresponding to case number 1. Upper left Plain lateral radiograph shows odontoid type III fracture. Upper right CT scan shows extension of fracture into the body of the axis. Lower left Sagittal T2-weighted MRI shows spinal cord hyperintensity at C2 level. Lower right Axial MRI depicts the extension of spinal cord hyperintensity limited to the left hemicord

Fig. 2

Images corresponding to case number 7. Upper left Plain lateral radiograph shows C5-C6 flexion-compression stage 3 fracture. Upper right CT scan shows fracture of the right lamina and through the body of C5. Lower left Sagittal MRI shows hyperintensity at the body of C5 and cord compression at C5-C6 without signs of hemorrhage. Lower right Axial T2-weighted MRI depicts the extension of spinal cord hyperintensity limited to the right hemicord