Cervical disc herniation causing Brown-Sequard syndrome: Case report and review of literature (CARE-compliant)

Abstract

Rationale: Brown-Sequard syndrome (BSS) is manifested as ipsilateral motor deficit and contralateral sensory loss. BSS caused by herniated cervical disc is extremely rare and easily be misdiagnosed, and clinical features of this problem were not fully understood.

Patient concerns: A 57-year-old man presented with a 3-month history of weakness in his right arm, and he experienced progressive right hemiparesis at 2 days before admission, along with contralateral deficit in sensation of pain and temperature below T2.

Diagnoses: Magnetic Resonance Imaging (MRI) showed severe cord compression due to a large paracentral extradural C4-C5 cervical disc herniation (CDH).

Interventions: Subtotal cervical corpectomy, decompression, and fusion through anterior approach were performed. The patient recovered rapidly after surgery.

Outcomes: Complete recovery of sensory and motor functions was obtained at a 4-months follow-up after surgery.

Lessons: Our case, along with a review of the literature, highlights that careful medical history inquiries, detailed neurologic examinations, and cervical spinal MRI scans are essential for diagnosis of CDH caused BSS. Prompt surgical decompression according to individual condition is commonly warranted. Early diagnosis with prompt surgical decompression could lead to favorable recovery.

Figure 1

Sagital (A) and axial (B) view of MRI demonstrating a large posterior right paramedian C4–C5 herniated disc severely compressing the spinal cord (arrow heads). CT (C) revealed evidence of spondylosis at C5–C7 vertebra and posterior vertebral osteophyte of C5 and C6 (arrow heads). Lateral (D) and frontal (E) X-ray performed after subtotal vertebrectomy of C5 and reconstruction with titanium mesh cages, as well as C6/7 cervical discectomy and fusion through anterior approach. CT = computed tomography.