Diagnosis of Brown-Séquard

Doctors make the diagnosis of Brown-Séquard syndrome and Brown-Séquard-plus syndrome on the basis of the patient’s medical history and physical examination.  Symptoms of Brown-Séquard as well as exam findings consistent with the condition lead to the diagnosis.   Doctors detect spastic paralysis with signs of increased muscle tone, increased reflex strength, and other abnormal neurological signs, as well as diminished sensation.

In most cases the cause of the syndrome is clear—traumatic injury.  In other cases the doctor must further analyze the history along with laboratory and imaging findings.   Lumbar puncture may be performed if diagnoses such as multiple sclerosis, transverse myelitis, tumor, or tuberculosis are suspected.  This procedure allows further analysis of the cerebrospinal fluid which cushions the spinal cord.  Other laboratory values might be obtained if other non-traumatic diagnoses are suspected.  Diagnoses of a tumor may require biopsy.

Imaging studies help confirm the diagnosis and determine the etiology of Brown-Séquard syndrome.   Plain X-rays are always performed first in cases of acute trauma to see if surgical intervention on the vertebral column is warranted.  More information about the exact nature of the injury is obtained by MRI, the imaging of choice for the condition, which gives great detailing of the cord itself.  A general CT might be performed to get a better look at the bony vertebra, or to evaluate other possible injuries in the case of traumatic Brown-Séquard.  A CT myelogram can be performed in persons unable to have an MRI.  Imaging reveals destruction or damage to nervous tissue on one lateral side of the spinal cord.  Depending on the suspected etiology, other imaging studies may be performed, such as angiography for suspected vascular malformation, or nuclear medicine scans in infectious or inflammatory causes.  A bladder catheterization may be performed to assess bladder dysfunction as well.

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