Brown Sequard

Syndrome
Hemisection or hemilesion of the spinal cord.
Uncommon case.
Clinical manifestation:
Loss of motoric function ipsilaterally (corticospinal
tract) UMN type
Proprioceptive disturbance ipsilaterally (posterior
column)
Loss of pain & temperature sensation
(exteroceptive function) contralaterally.

Etiology
Spinal cord tumor
Trauma : penetrating injury (gun shot, etc)
Ischemic
Hemorrhage
Infection or inflammation: tuberculosis,
multiple sclerosis

Exteroception

Example: lesion in the left side

Spastic paralysis
Flaccid paralysis
All sensoric function is disturbed
Proprioceptive dysfunction
Loss of pain & temperature sensation

SYRINGOMYELIA

Syringomyelia
A chronic progressive degenerative disorder
of the spinal cord, caused by gliosis & tubelike (syrinx) cavity in the central part of the
spinal cord (medulla).
Male > female, 25 40 years old
Syrinx is usually in the lower cervical & upper
thoracal segment (can extend upward to the
medulla oblongata or downward into the
lumbar segments.

Etiology
Based on theory:
Old theory :
1. Central canalis is not completely closed
leaving cavity & secondary gliosis
2. In the closing process, rest of spongioblast
in the central canal form glial tissue
forming a cavity
3. Chronic Glioma cystic degeneration

Etiology
New theory:
1. Obstruction of outlet of the fourth ventricle.
Found in: Arnold Chiary malformation
(protrution of cerebellar tonsil foramen
magnum) or Dandy Walker malformation
no For.magendi & for. Luschka.
2. Artery pulsation pulsation in the fourth
ventricle (Gardners theory)
Both process cause formation of cavity in the
spinal cord.

Clinical manifestation
Dissociated sensory loss (pain & temp.
is disturbed, BUT proprioceptive is
intact).
If Corticospinal tract is afected
spastic paraparesis (UMN type)
destruction of motoric neurons in the
anterior horn paresis LMN type

autonomic tracts involeved:

micturation & defecation disturbance
spastic bladder.

SPECIAL EXAMINATION
LP : ~ Normal pressure
~ Increased protein level

~ Queckenstedt is negative if blocking

persist

Radiologic Examination
Abnormalities of vertebral column X-ray
abnormal development process.
Klippel feil Syndrom (Fusion)
Platybasia
Basilar invagination
Spina bifida
Cervical Rib