Brown-Séquard-plus syndrome because of penetrating trauma in children

Stabbing injury of the spinal cord: A case report and systematic literature review

BACKGROUND

Spinal cord injury caused by stab wounds (SCISW) represents one of the rarest causes of traumatic spinal cord injury. Because of their rarity, management of such cases may be challenging due to the lack of specific guidelines.

METHODS

The systematic review was performed on 30th June 2024 according to the PRISMA 2020 guidelines. A literature search was conducted across four databases: PubMed, Scopus, Web of Science, and The Polish Medical Bibliography. Additionally, a unique case was presented as an illustrative clinical presentation.

RESULTS

A total of 89 eligible articles, including 78 case reports (89 patients) and 11 case series (882 patients), were found. The current report describes a case of a 41-year-old man with one neck stab wound and a stab wound of the chest. Clinical examination demonstrated complete paraplegia and a lack of sensation below the level of T1. Magnetic resonance imaging (MRI) showed a complete transection of the spinal cord at the T1-T2 level. Due to the lack of foreign bodies at the injury site, the patient was managed conservatively.

CONCLUSION

Direct stabbing injuries rarely lead to complete transection of the spinal cord as in our case. Computed tomography (CT) scans or plain radiographs are necessary to exclude retained foreign bodies. MRI as a further imaging tool can confirm the SCI and may be useful as a predictor of outcomes. Regarding optimal management, conservative treatment should be preferred over surgical intervention in the absence of a foreign body at the injury site.

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

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.

An arrow that missed the mark: a pediatric case report of remarkable neurologic improvement following penetrating spinal cord injury

Penetrating spinal cord injuries are rare in children but result in devastating impacts on long-term morbidity and mortality-with little known about the recovery capacity in this age group. We present the case of an eight-year-old child who sustained a penetrating injury through the right anterior thorax. Thoracic CT showed the arrow tip extending through the spinal canal at T6. Neurologic examination revealed no motor or sensory function below T6. The arrow was surgically removed without complications through an anterior-only approach. MRI on post-operative day (POD) 4 showed focal T2 hyperintensity at the T6 spinal cord. Patient was discharged on POD33 with an American Spinal Injury Association (ASIA)-D score and trace voluntary control over bowel and bladder function. Remarkably, four months later, he had near normal bowel and bladder function, with near-intact lower extremity strength and self-sustained ambulation. Follow-up imaging revealed hemicord formation at the level of injury. We review our case of penetrating spinal cord injury in a child and similar reports in the literature. Penetrating thoracic spinal cord trauma portends poor clinical outcomes, particularly when employing available adult prognostic spinal cord injury scoring metrics. Incomplete spinal cord injury, and often-associated spinal shock, can mimic a complete injury-as in our patient, which improved to near-complete motor and sensory restoration of function and resulted in the formation of a split hemicord. This case represents a unique penetrating spinal cord injury with remarkable neurologic recovery, which would advocate against definitive early prognostication in the pediatric population.

Traumatic Brown-Séquard syndrome: modern reminder of a neurological injury

Brown-Séquard syndrome (BSS) presents as an ipsilateral loss of motor function, proprioception and vibratory sensation accompanied by contralateral pain and temperature loss two to three levels below the level of the injury. It is one of the syndromes associated with incomplete transection of the spinal cord. Classic BSS is rare as most patients present with mixed neurological deficits related to damage of the spinal cord and surrounding structures. BSS remains prevalent in areas with high trauma burden, where assaults with sharp weapons are common. We present the case of a man aged 38 years who sustained a stab injury to the left back. BSS was diagnosed. He underwent removal of the weapon in the operating room and had an uneventful recovery to near baseline functional level after a course of rehabilitation. Despite being a rare aetiology, BSS continues to be an excellent reminder to trauma providers of the anatomy and physiology of neuroanatomical tracts.

Case of Brown Sequard syndrome with ipsilateral peripheral vasodilation

Brown-Sequard Syndrome is a neurologic disorder caused by partial spinal cord injury and disruption of the corticospinal tract, dorsal columns, and spinothalamic tract. We present a 32-year-old male with partial T11-12 cord transection due to a penetrating knife injury. In addition to the classical neurological symptoms of Brown-Sequard Syndrome, he also exhibited ipsilateral peripheral vasodilatation below the level of injury. This finding is attributed to the disruption of the intermediolateral columns of the spinal cord and impaired sympathetic tone on the peripheral vasculature. Awareness of this finding can raise the radiologist's suspicion for spinal cord injury in the setting of trauma and peripheral vasodilation.

Delayed diagnosis of traumatic gunshot wound Brown-Sequard-plus syndrome due to associated brachial plexopathy

Introduction

Brown-Séquard Syndrome (BSS) is one of the rarest incomplete spinal cord syndromes. The combination of injuries to peripheral nerves and the central nervous system result in an array of symptoms that can result in overlapping clinical presentations and delayed diagnosis. Early detection of spinal cord injury in patients with peripheral nerve injury has been observed to have a positive effect on outcomes.

Case presentation

This report discusses the case of a 29-year-old male patient with Brown-Sequard-Plus Syndrome (BSPS) and Brachial Plexopathy (BP) secondary to gunshot wound in the left inferior neck. The patient was found initially with left hemibody weakness. A chest CT Scan demonstrated a fracture of the left T2 transverse process. Imaging studies of the spinal cord were not performed in the acute setting. Evaluation in an outpatient setting 3 weeks later showed significant left upper extremity weakness with improvement of left lower extremity strength. Also present were loss of pain and temperature sensation on the right side below the T2 dermatome level. A cervico-thoracic MRI was requested and revealed a T2 level spinal cord contusion. Electrodiagnostic studies confirmed a lower trunk left BP.

Discussion

The patient was diagnosed with BSPS and associated left lower trunk BP. To our knowledge, this is the first reported case of a concomitant BSPS and BP secondary to a gunshot wound. Delayed diagnosis of BSPS may occur in a trauma setting underlying the importance of a detailed history and physical examination for favorable outcomes.

Scissors stab wound to the cervical spinal cord at the craniocervical junction

BACKGROUND CONTEXT

Stab wounds resulting in spinal cord injury of the craniocervical junction are rare. A scissors stab wound to the cervical spinal cord has been reported only once in the literature.

PURPOSE

This paper aimed to report a case of Brown-Séquard-plus syndrome in an 8-year-old boy secondary to a scissors stab wound at the craniocervical junction.

STUDY DESIGN

Case report and review of the literature.

PATIENT SAMPLE

Case report of an 8-year-old boy accidentally stabbed in the neck by scissors, which were thrown as a dart.

METHODS

The case study of an 8-year-old boy who was hospitalized because of a scissors stab wound at the craniocervical junction. The patient developed Brown-Séquard-plus syndrome on the left side of the body. Magnetic resonance imaging revealed a laceration of the spinal cord at the craniocervical junction with cerebrospinal fluid leakage. Careful cleansing and interrupted sutures of the wounds were performed to prevent cerebrospinal fluid leakage. Rehabilitation therapy was performed 2 days later.

RESULTS

A follow-up examination revealed complete recovery of the neurologic deficit 8 months post-injury.

CONCLUSION

Treatment of scissors stab wounds to the cervical spinal cord, whether conservative management or thorough surgical exploration, should be individualized based on history, examination, and imaging. As shown in this case report, despite conservative management, complete recovery, which was unexpected, was attributed to the initial mild laceration of the spinal cord and ipsilateral spinal cord functional compensation.

Brown-Séquard syndrome in a 11-year-old girl due to penetrating glass injury to the thoracic spine

Injuries in children are one of the most frequent causes of high morbidity and mortality, and they present a challenge to the treating physician. Fortunately, spinal trauma in pediatric patient is relatively rare. Brown-Séquard syndrome is a rare form of incomplete spinal cord injury consisting of ipsilateral upper motor neuron paralysis (hemiplegia) and loss of proprioception with contralateral pain and temperature sensation deficits resulting from hemisection or lateral injury to the spinal cord. A 11-year-old girl was admitted to our Pediatric Trauma Emergency Department after she had suffered a penetrating back injury. Neurological examination demonstrated left lower extremity paresis and moderate spastic paralysis of the right lower extremity. The examination showed loss of temperature sensation contralateral to and below the lesion. The examination of the pain sensation was difficult because the patient was in pain shock, but it was diminished on the side opposite to the damage. Multislice spiral computed tomography (MSCT) demonstrated a triangular foreign body in spinal canal at the level of the Th11–Th12. After a Th₁₁–L₂ laminectomy and retrieval of foreign bodies, dura repair was performed. Patient was discharged from the hospital with partial recovery. Operative decompression of the neural elements in case of spinal canal compromise is the treatment of choice. Indication for surgical intervention in existing cerebrospinal fluid fistula includes closure of the dura and reducing neural elements compression and lowering the risk of infectious complications by removing bone or foreign body fragments. Patients with Brown-Séquard syndrome have good prognosis for functional recovery.