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Trigger 2
               SUMMARY
 Hemisection of the spinal cord (Brown
  Sequard Syndrome)
Trigger 2
 Mr. Y, 40 years old, was in a traffic accident and
  was taken to the Emergency unit. The patient
  was still ...
Keywords:

 Paralysis of the right side of the body
 Loss of pain sensation of the left side of the
  body, starting fro...
Where is the probable site of
lesion in the nervous system??

  According to the dermatom area, the patient
   got loss o...
The injured tracts :

Sensory:
 Spinothalamic tract
  (pain, temperature,
  touch, pressure)
  from the left side of
  th...
MOTOR:
 Lower motor neuron in
  the area of the lesion eg.
  C5-6 that innervate
  biceps muscle.
                       ...
Muscle paralysis:
 LMN paralysis : LMN in the spinal cord at the
  level of the lesion (C3,4,5,6..)
   C3-4 innervate di...
Two point discrimination (using
calipers) :
 Left side of the body can differentiate two
  point
 Right side of the body...
Horner syndrome :
 Lesion on sympathetic fibers which innervate
  the head region.
   Preganglionic neuron : intermediol...
Case: Hemisection of The Spinal Cord
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Case: Hemisection of The Spinal Cord

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Review on Case Hemisection of the Spinal Cord (Brown Sequard Syndrome)
This case is a trigger in Neuroscience Module in Medical Faculty University of Indonesia

Published in: Health & Medicine
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Case: Hemisection of The Spinal Cord

  1. 1. Trigger 2 SUMMARY  Hemisection of the spinal cord (Brown Sequard Syndrome)
  2. 2. Trigger 2  Mr. Y, 40 years old, was in a traffic accident and was taken to the Emergency unit. The patient was still conscious but could not walk unaided. Paralysis cover his right arm and legs. On examination, a hematoma was found on the back of his neck. He could not feel any sensation of pain on his left starting from his foot up to the base of his neck. Physical examination revealed right biceps reflex and right patellar reflex were negative. The pupil of his left eye was constricted, with ptosis and enophthalmus.
  3. 3. Keywords:  Paralysis of the right side of the body  Loss of pain sensation of the left side of the body, starting from the neck down.  Right biceps reflex and right patellar reflex were negative.  Pupillary constriction, ptosis, and enophthalmus of the right eye
  4. 4. Where is the probable site of lesion in the nervous system??  According to the dermatom area, the patient got loss of sensation up to segment C3 of dermatom (Base of the neck is C2-3) .Thus, the probale site of the lesion is on C3 or bellow C3 segment of the spinal cord.  Since the paralysis is on the right side, the lesion must be on the right section of the spinal cord (look at the picture)
  5. 5. The injured tracts : Sensory:  Spinothalamic tract (pain, temperature, touch, pressure) from the left side of the body  Fasciculus gracilis dan cuneatus Fasciculus gracilis dan cuneatus (proprioception and Spinothalamicus discriminative touch) from the right side of the body
  6. 6. MOTOR:  Lower motor neuron in the area of the lesion eg. C5-6 that innervate biceps muscle. LMN  Corticospinal tract (UMN axon) that will end in UMN spinal cord segment bellow the lesion LMN
  7. 7. Muscle paralysis:  LMN paralysis : LMN in the spinal cord at the level of the lesion (C3,4,5,6..)  C3-4 innervate diaphragm  breathing difficulty  C5-6 innervate biceps  flaccid paralysis, reflex (-)  UMN paralysis : affected the corticospinal tract (UMN axons) that will end in the spinal cord segment bellow the lesion  spastic paralysis.  Patellar reflex :  Negative : due to spinal shock (0-1 day)  positive: 1 – 7 day  Hyperreflex : 1-4 week  spasticity
  8. 8. Two point discrimination (using calipers) :  Left side of the body can differentiate two point  Right side of the body cannot differentiate two point
  9. 9. Horner syndrome :  Lesion on sympathetic fibers which innervate the head region.  Preganglionic neuron : intermediolateral horn of the T1 segment of the spinal cord  Postganglionics neuron: superior cervical ganglion  Pupillary constriction: due to paralysis of the dilator muscle of the eye  Pseudoptosis : due to paralysis of the levator palpebra superior muscle (smooth muscle part)  Enophthalmus: due to narrowing of the palpebral fissure (not true enophthalmus)

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