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BY ASSMAA FREAH
121-i1b
BROWN SEQUARD
SYNDROME (BSS)
PLAN
CAUSES
How it occurs
What are the main
causes
Can he be completely
cured
How is it treated
The Diagnosis
What’s happening
during it
TREATMENT
SYMPTOMS
01 02 03
BACKGROUND
Brown sequard syndrome which is
also known as transverse hemisection
syndrome or Hemiplegia syndrome
It’s a disease when one half of the
spinal cord is injured or damaged that’s
why it’s Classified as an incomplete
cord syndrome
Charles-Édouard Brown-Séquard
SENSORY AND
MOTOR
INFORMATION
Sensation-stimulated
receptors passes the
information to the CNS
via afferent (sensory)
fibers (ascending
pathways)
NEURAL TRACTS
Passes information
from the CNS to the
muscles and nerves to
produce a rapid
motor response
(Descending pathways)
MOTOR
SENSORY
ASCENDING PATHWAYS
-Contain a sequence of THREE neurons from the
receptor to the cerebral cortex
-First order neuron: Sensory neuron that delivers
information from the receptor to the CNS.
-Second order neuron: Has cell body in the spinal
cord or medulla oblongata. And terminates on the 3rd
order neuron
-Third order neuron: Has cell body in thalamus Axon
terminates on cerebral cortex ipsilaterally
DESCENDING
PATHWAYS
-Contain a sequence of TWO neurons from the
CnS to the muscle
-UMN: delivers information from the cerebral
hemisphere to the spinal cord
LMN: delivers information from the anterior horn cells
to the muscle
SENSORY AND MOTOR PATHWAYS
-Ipsilateral loss of
proprioception due to
posterior column
involvement.
-Contralateral loss of
pain and temperature
due to involvement of
lateral spinothalamic
tract.
SYMPTOMS
-Ipsilateral spastic
weakness due to
descending
corticospinal tract
involvement
-LMN signs at the level
of lesion.
MOTOR
SENSORY
BSS DIAGNOSIS
Diagnosis of Brown sequard Syndrome is made
by neurological history, any trauma history, and
physical examination. Laboratory investigations in
case of infectious etiologies like purified protein
derivative and sputum for acid-fast bacilli along with
chest x-ray. MRI or X-ray when traumatic injuries
are in suspected as well as neoplastic causes.
CAUSES
BROWN SEQUARD SYNDROME may
occur as a result of spinal cord damage
caused by spinal cord tumors, injuries
[such as falls, gunshot injury], ischemia,
infectious or inflammatory diseases
such as tuberculosis or multiple
sclerosis.
BSS PATHOPHYSIOLOGY
Damage of Corticospinal tract below the
level of pyramidal decussation:
• Corticospinal tract crosses at the level of
the brainstem, the lesions below it will
produce ipsilateral symptoms.
• Ipsilateral Upper Motor Neuron Lesions
below the level of injury
BSS PATHOPHYSIOLOGY
2. Damage of Lower Motor Neurons at the
level of Injury:
• Ipsilateral Lower Motor Neuron Lesions at
the level of injury
BSS PATHOPHYSIOLOGY
3. Damage of Dorsal column below the level
of sensory decussation:
• Dorsal column crosses at the level of the
brainstem, the lesions below it will
produce ipsilateral symptoms.
• Ipsilateral loss of joint position sense,
tactile discrimination, fine touch and
vibratory sensations at and below the
level of injury.
BSS PATHOPHYSIOLOGY
4. Damage of Spinothalamic tract:
• Information ascends contralaterally in the spinal
cord (crosses in the spinal cord).
• Carries fibres for Pain, Temperature and Crude
Touch.
• At the level:
• Ipsilateral loss of:
• Pain
• Temperature
• Crude touch
• Because fibers are
• not crossed yet at that level
Below the level:
-Contralateral loss of:
Pain
Crude touch
BSS TREATMENT
The treatment for individuals with Brown-Sequard
syndrome depends on the cause and is focused
on preventing the complications. Use of steroids
is controversial in traumatic spinal cord injuries
due to the risk of infections, and they are not
effective in case of Brown-Sequard syndrome,
but standard perioperative prophylactic
antibiotics are recommended.

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Brown sequard syndrome

  • 1. BY ASSMAA FREAH 121-i1b BROWN SEQUARD SYNDROME (BSS)
  • 2. PLAN CAUSES How it occurs What are the main causes Can he be completely cured How is it treated The Diagnosis What’s happening during it TREATMENT SYMPTOMS 01 02 03
  • 3. BACKGROUND Brown sequard syndrome which is also known as transverse hemisection syndrome or Hemiplegia syndrome It’s a disease when one half of the spinal cord is injured or damaged that’s why it’s Classified as an incomplete cord syndrome Charles-Édouard Brown-Séquard
  • 5. Sensation-stimulated receptors passes the information to the CNS via afferent (sensory) fibers (ascending pathways) NEURAL TRACTS Passes information from the CNS to the muscles and nerves to produce a rapid motor response (Descending pathways) MOTOR SENSORY
  • 6. ASCENDING PATHWAYS -Contain a sequence of THREE neurons from the receptor to the cerebral cortex -First order neuron: Sensory neuron that delivers information from the receptor to the CNS. -Second order neuron: Has cell body in the spinal cord or medulla oblongata. And terminates on the 3rd order neuron -Third order neuron: Has cell body in thalamus Axon terminates on cerebral cortex ipsilaterally
  • 7. DESCENDING PATHWAYS -Contain a sequence of TWO neurons from the CnS to the muscle -UMN: delivers information from the cerebral hemisphere to the spinal cord LMN: delivers information from the anterior horn cells to the muscle
  • 8. SENSORY AND MOTOR PATHWAYS
  • 9. -Ipsilateral loss of proprioception due to posterior column involvement. -Contralateral loss of pain and temperature due to involvement of lateral spinothalamic tract. SYMPTOMS -Ipsilateral spastic weakness due to descending corticospinal tract involvement -LMN signs at the level of lesion. MOTOR SENSORY
  • 10. BSS DIAGNOSIS Diagnosis of Brown sequard Syndrome is made by neurological history, any trauma history, and physical examination. Laboratory investigations in case of infectious etiologies like purified protein derivative and sputum for acid-fast bacilli along with chest x-ray. MRI or X-ray when traumatic injuries are in suspected as well as neoplastic causes.
  • 11. CAUSES BROWN SEQUARD SYNDROME may occur as a result of spinal cord damage caused by spinal cord tumors, injuries [such as falls, gunshot injury], ischemia, infectious or inflammatory diseases such as tuberculosis or multiple sclerosis.
  • 12. BSS PATHOPHYSIOLOGY Damage of Corticospinal tract below the level of pyramidal decussation: • Corticospinal tract crosses at the level of the brainstem, the lesions below it will produce ipsilateral symptoms. • Ipsilateral Upper Motor Neuron Lesions below the level of injury
  • 13. BSS PATHOPHYSIOLOGY 2. Damage of Lower Motor Neurons at the level of Injury: • Ipsilateral Lower Motor Neuron Lesions at the level of injury
  • 14. BSS PATHOPHYSIOLOGY 3. Damage of Dorsal column below the level of sensory decussation: • Dorsal column crosses at the level of the brainstem, the lesions below it will produce ipsilateral symptoms. • Ipsilateral loss of joint position sense, tactile discrimination, fine touch and vibratory sensations at and below the level of injury.
  • 15. BSS PATHOPHYSIOLOGY 4. Damage of Spinothalamic tract: • Information ascends contralaterally in the spinal cord (crosses in the spinal cord). • Carries fibres for Pain, Temperature and Crude Touch. • At the level: • Ipsilateral loss of: • Pain • Temperature • Crude touch • Because fibers are • not crossed yet at that level Below the level: -Contralateral loss of: Pain Crude touch
  • 16. BSS TREATMENT The treatment for individuals with Brown-Sequard syndrome depends on the cause and is focused on preventing the complications. Use of steroids is controversial in traumatic spinal cord injuries due to the risk of infections, and they are not effective in case of Brown-Sequard syndrome, but standard perioperative prophylactic antibiotics are recommended.