Brown sequard syndrome

Brown sequard syndrome or transverse hemisection syndrome
Causes symptoms and treatment of brown sequard syndrome
Background about the disease
Neural tracts
Ascending and descending pathways of the spinal cord (motor and sensory pathways)
Pathophysiology of 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

4. SENSORY AND MOTOR INFORMATION

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.