Brown-Sequard syndrome associated with Horner syndrome following cervical disc herniation

Abstract

Introduction: Brown-Sequard syndrome (BSS) has been reported in patients with various spinal pathologies, including spinal traumatic injuries, spinal cord neoplasms, epidural hematomas and spinal cord ischemia. Pure BSS caused by cervical disc herniation is very rare.

Case presentation: We report a rare case of cervical disc herniation presenting as BSS associated with Horner syndrome (HS), which has not been reported up to now. A prompt diagnosis by magnetic resonance imaging (MRI), followed by spinal cord decompression was performed. A postoperative rapid improvement of the neurological deficits was observed.

Discussion: We review the literature and discuss the functional anatomy of spinal cord of BSS combined with HS. And it is important that clinicians be aware that a MRI of spinal cord is needed for those patients with a thoracic sensory level, and that a thoracic sensory level might not only depend on the level of spinal cord injury but also on the stage of evolution of the lesion.

Keywords: Development of the nervous system; Neurodegenerative diseases.

Figure 1

Right-sided ptosis and miosis secondary to Horner’s syndrome preoperatively (upper). Msis and ptosis of the right side were dramatically recovered at 2 months after surgery (lower).

Figure 2

Sagittal and axial T2-weighted magnetic resonance imaging of the cervical spine, showing a large central and right-sided extradural C5–C6 disc herniation compressing the right side of the spinal cord and a small central and extradural C3–4 disc herniation.