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Case Reports
. 2022 Aug 17:10:2050313X221116945.
doi: 10.1177/2050313X221116945. eCollection 2022.

An unusual case of Brown-Sequard syndrome associated with Horner's syndrome after a penetrating injury with a khuru (Bhutanese dart) to the neck: A case report

Kuenzang Wangdi  1
Affiliations
Case Reports

An unusual case of Brown-Sequard syndrome associated with Horner's syndrome after a penetrating injury with a khuru (Bhutanese dart) to the neck: A case report

Kuenzang Wangdi. SAGE Open Med Case Rep. .

Abstract

The occurrence of Brown-Sequard syndrome with Horner's syndrome in a child with spinal trauma is a very rare and unusual entity. Brown-Sequard syndrome results from hemisection injury of the spinal cord, mostly in the cervical cord region. The Horner's syndrome presents when the injury is in the cervical region involving the sympathetic pathway. We present you with the case of a 12-year-old boy who was referred from a local hospital with weakness on the left half of his body after sustaining a penetrating injury to his neck by a khuru (Bhutanese dart). Clinical examination was consistent with the diagnosis of Brown-Sequard syndrome with ipsilateral Horner's syndrome. Although cervical spine plain radiographs showed no fracture, computed tomography and magnetic resonance imaging showed a C2 lamina fracture at the left side of the spinous process with indentation to the cord. He was managed conservatively with a soft cervical collar, intravenous antibiotics, and physiotherapy. He had complete resolution of Brown-Sequard syndrome and Horner's syndrome after 1 year. Patients with Brown-Sequard syndrome associated with Horner's syndrome usually have a good prognosis and full recovery rate with regular physiotherapy and rehabilitation. Early diagnosis and treatment will have a better chance of recovery and return to pre-injury status.

Keywords: Brown-Sequard syndrome; Horner’s syndrome; cervical region; dart; khuru; penetrating injury.

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Conflict of interest statement

Declaration of conflicting interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.
Figure 1.
Partial ptosis of left eyelid of our patient (image was taken with consent from boy’s parents).
Figure 2.
Figure 2.
CT-cervical spine. (a) and (b) C2 lamina fracture on the left side, red circle (axial view). (c) 3-D image of cervical spine showing a small bony defect (black arrow). (d) The sagittal view of cervical spine showing a bony fragment inside the spinal canal (black arrow).
Figure 3.
Figure 3.
MRI of cervical spine. (a) Axial view C2 lamina fracture showing indentation to the cord, red arrow (axial view). (b) Sagittal view showing C2–C4 cord edema (red circle).
Figure 4.
Figure 4.
(a) Khuru (Bhutanese dart) and (b) players gathering around the target (images taken with permission from players).
See this image and copyright information in PMC

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