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Introduction: Brown-Séquard syndrome due to a stab injuries is uncommon and results from a lesion in one half of the spinal cord., Background: The role of surgery in the treatment of penetrating spinal injury often remain controversial., Aim: To discuss the current diagnostic and therapeutic approach for these types of injuries., Materials and Methods: The Authors describe two rare cases of Brown-Séquard syndrome due to civilian stab injuries differently treated. Mechanism of damage, clinical features and neurological outcome are reported., Results: The recovery of neurological function in the first case indicates that the spinal tracts were injured by a contusion, rather than by a direct injury as in the second case. Moreover, surgery was required in the second patient to remove the weapon and to stabilize the spine, presenting bony and ligamentous instability., Discussion: The diagnostic and therapeutic management are debated. An overview on clinical research in sperimental medical treatment of spinal cord injury was considered to evaluate future possible approaches to these injuries., Conclusions: As the neurologic improvement depends on the type and severity of the spinal cord damage, the indications for acute surgical management are limited and conservative management should be preferred.

Brown-Sequard syndrome secondary to compression of the spinal cord by an epidural haematoma following minor trauma is rare. A 65-year-old woman presented with neck pain and sudden onset hemiplegia with contralateral anaesthesia. Magnetic resonance imaging showed a haematoma in the epidural space in the C3 to C5 levels. She underwent open-door laminoplasty for evacuation of the haematoma. At the 2-year follow-up, she had regained normal sensations and a neurological grade of 5/5.

Background Context: Brown-Séquard syndrome is characterized by a hemisection of the spinal cord most commonly after spinal trauma or neoplastic disease. The injury causes ipsilateral hemiplegia and proprioceptive sensory disturbances with contralateral loss of pain and temperature sensation. Patients with Brown-Séquard syndrome have the best prognosis of all spinal cord injury patterns. At this time, the ideal management for Brown-Séquard syndrome after penetrating trauma has yet to be defined., Purpose: To report a case of a gun shot wound to the upper cervical spine that resulted in Brown-Séquard syndrome and was treated effectively with early cervical spine decompression and fusion., Study Design: Observational case report., Methods: A 28-year-old woman presented after sustaining a low-velocity gun shot wound in to the upper cervical spine in a civilian assault. On initial presentation, she had 0/5 motor scores in the left upper and lower extremities and normal motor scores on the right. Sensory examination was limited as she was intubated and sedated on admission due to airway compromise. A computed tomography scan revealed a bullet lodged in the vertebral body of C3 with boney fragments and soft tissue encroaching on the spinal cord. Subsequently, she underwent C3 corpectomy, bulletectomy, and anterior cervical decompression with fusion., Results: Intraoperatively, no dural disruption or cerebral spinal fluid leak was noted, and her posterior longitudinal ligament was intact. One month postoperatively, her left lower extremity motor score was 5/5 with movement of her left thumb and all fingers. Strength in her biceps, triceps, and wrist extensors and flexors was 3/5. Her functional capacity and strength gradually improved., Conclusions: Reinke et al. support surgical intervention for patients with incomplete paraplegia after the patient is medically stabilized, although their case report discussed lower thoracic injury, which carries a more favorable prognosis. All other prior case reports and prospective studies that reported favorable outcomes after Brown-Séquard syndrome involved the midthoracic, low thoracic, or lumbar spinal levels. This report is the first case of Brown-Séquard syndrome after a high cervical gun shot wound, which was managed with immediate decompression and fusion, where near complete recovery was obtained., (Copyright © 2013 Elsevier Inc. All rights reserved.)

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.

Study Design: A case report., Objectives: To present a case of postpartum hypogalactia in a woman with Brown-Séquard-plus syndrome (BSPS)., Setting: Outpatient spinal cord injury (SCI) clinic., Case Report: A 33-year-old woman with C4 AIS D tetraplegia (American Spinal Injury Association Impairment Scale) was followed at the outpatient SCI clinic for the past 5 years. Her right side presents with increased tone, increased spasticity and decreased sensitivity to light touch. Conversely, her left side presents with minimal changes in tone and no motor function deficits, but decreased sensitivity to pinprick and temperature sensation. These findings are consistent with BSPS. After inpatient rehabilitation, she was engaged, married, and 8 months ago delivered a healthy child. After an uncomplicated delivery, breastfeeding was attempted, but a significant lack of lactation was noted the first month postpartum from the right breast. Despite the implementation of measures to increase lactation, the lack of lactation from the right breast persisted, and required initiation of formula feeding. The right breast in this case lost not only sensory proprioception, but also autonomic control, which could contribute to this instance of asymmetric lactation., Conclusion: In addition to motor and sensory dysfunctions following SCI, autonomic dysfunctions are commonly seen in individuals with these devastating injuries. The lactation on the right side, which had interrupted descending spinal autonomic pathways, was decreased by approximately 83%. This case provides us with interesting information regarding attention that clinicians should be paying when discussing the breastfeeding options for women with SCI.

Spontaneous spinal epidural hematoma (SEH) is a rare disease. Furthermore, Brown-Séquard syndrome due to spontaneous SEH has been rarely reported. Early detection of spontaneous SEH is not easy because early symptoms are often atypical and neurologic findings are often absent in the early stage. Early diagnosis and urgent surgical management are needed to prevent permanent neurologic deficits. We report a case of a 30-year-old patient who presented with Brown-Séquard syndrome due to spontaneous SEH. The patient has recovered successfully without any complications through surgical decompression within 12 hours of onset.

Aim: To raise the awareness of the appropriate management of unusual clinical presentation of cervical disc herniation., Material and Methods: Seven patients with Brown-Sequard syndrome due to cervical disc herniation presented with Brown-Sequard syndrome had been treated surgically as one of them treated with anterior cervical discectomy and three patients treated by anterior cervical discectomy and fusion while three of them have been treated by posterior laminectomy., Results: Patients were 7 three of them were female and four were males and the mean age of our patients is 45.28 ± 16.49 years ranged between 32 and 72 years. History of spinodegenerative disease in the form of chronic neck pain with or without brachialgia was found in 6/7 patients (85.7%) while history of trauma was found in 5/7 patients (71.4%). Most common affected level is C5-C6 disc Outcome after surgical treatment revealed complete recovery in 4/7 patients (57.1%) while incomplete recovery in 2 patients (28.6%) and no improvement in one patient (14.3%)., Conclusion: Brown-Sequard syndrome is a rare presentation of cervical disc herniation but accurate diagnosis, and early anterior spinal cord decompression lead to complete recovery of these cases.

Study Design: Several causes of Brown-Sequard syndrome have been described. Endovascular embolization can be used to treat symptomatic vertebral hemangiomas. We describe a previously undocumented case of Brown-Sequard syndrome followed by endovascular embolization with microcoils of a vertebral hemangioma. We also provide a clinical-radiological correlation of this finding and review the relevant literature., Case Report: A 39-year-old male was referred to our hospital for endovascular treatment of a right T9 hemivertebral hemangioma with compromise of the spinal canal. Fifteen minutes after the procedure, the patient developed right lower limb weakness and numbness on the left leg. The emergency magnetic resonance imaging (MRI) of the spine showed no abnormalities. Five days later, a new spinal MRI revealed an infarction in the right half of the spinal cord at T6 and T7 level. This stroke was probably caused by a microcoil ended up in the right sulcocommisural artery. One week after surgery, the patient was able to raise the right leg against gravity, but sensory deficit showed no improvement., Conclusions: To the best of our knowledge this is the first case of a Brown-Sequard syndrome related to vertebral hemangioma embolization, a relatively safe technique with no important complications made known until this report. Clinicians should always weight the benefits with the potential devastating complications of this therapeutic option.

Decompression sickness often manifests as central nervous system impairment. We report a 49-year-old woman who developed an unusual case of spinal cord decompression sickness presenting as complete Brown-Sequard syndrome. Initial MRI revealed increased signal intensity in the left side of the cervical cord at the level of C2-C3. A second MRI at 10 days post-injury showed signal abnormalities corresponding to an infarction in the posterior spinal artery territory. After two weeks of intensive treatment with various HBOT regimens, the clinical outcome was still poor, but at six months after the injury her neurological condition was greatly improved, with only slight impairment of proprioception on the left when walking remaining.

Introduction: Brown-Sequard syndrome is an incomplete spinal cord lesion characterized by ipsilateral loss of motor function and contralateral loss of pain and temperature sensitivity, reflecting a hemi-compression or hemi-section of the spinal cord. Cervical disc herniation is an exceptional cause of this syndrome., Material and Methods: We report a case of cervical disc herniation causing Brown-Sequard syndrome in a patient with an unusually rapid neurological deterioration associated to cervical extension, which was documented by neuromonitoring., Conclusion: A prompt diagnosis, followed by spinal cord decompression should be warranted. Intraoperative neuromonitoring is a useful tool in preservation of neurologic function in these cases.

An odontoid fracture leading to Brown-Sequard syndrome (BSS) is an uncommon condition with only seven cases reported to date. To our knowledge, there are no reports of occurrence in paediatric patients. We report a paediatric odontoid fracture leading to Brown-Sequard syndrome (BSS) with satisfactory recovery following surgical treatment. Odontoid fractures may lead to Brown-Sequard syndrome in cases of high-energy trauma in paediatric patients. Direct anterior screw fixation may be a treatment of choice in paediatric odontoid fractures of the comminuted, displaced type when occurring in conjunction with neurologic injuries.

Introduction: Spinal stab wound injuries are quite rare and only few patients have been reported on the basis of MRI scan., Methods: A 25-year-old man was stabbed at C1/2 and had an incomplete Brown-Sequard syndrome. He underwent surgical exploration because of CSF leakage on the fourth day., Results: After a follow-up period of 32 months, he was left with a remaining loss of the proprioception of the right foot. We show detailed CT and MR images with the focus on the lesions of the dura and myelon and compared them with intraoperative images. In addition, we contrast our findings with a review of literature published over the last three decades., Conclusion: MRI gives the most detailed view of soft tissue lesions in SSWs and is in accordance with our intraoperative findings.

Introduction: Extradural arachnoid spinal cysts are unfrequent lesions that are associated with spinal trauma, surgery and less frequently with congenital anomalies. The clinical manifestations are similar to those seen with other compressive spinal cord lesions. Magnetic resonance techniques allow to diagnose correctly this pathology and to define its thopographic situation. The pathologic history of the patient is essencial to establish the ethiology. Surgery is the elective treatment in most cases., Clinical Case: The patient is a 35 years old man who has a medical history of penetrating spinal trauma two years ago. In that instance he suffered an unilateral spinal cord section at D2-D3 level with the corresponding Brown Sequard syndrome. A small wound was detected at the skin dorsal level and it was closed without difficulties. At the beginning, he improved his motor right leg function with rehabilitation and vitamins. After two years of good recovery he came to our hospital suffering a neurological deterioration of six months of evolution. The physical examination revealed an spastic paraparesis. Magnetic resonance was performed demonstrating a cystic extradural collection compressing the spinal cord at D3-D4 level. Surgical decompressive treatment allowed to excise the cyst and it was possible to define a dural tear that was closed successfully. The outcome was good with restoration of the initial motor function that he had after the spinal trauma., Conclusions: Surgical management of postraumatic epidural arachnoid spinal cyst allows to detect the meningeal tear and to close it, which is highly effective on these kinds of lesions.

Background: Traumatic spinal cord injuries on cervical canal stenosis represent a steadily increasing pathology, of which clinical and functional outcomes remain largely unknown., Material and Methods: We present the results of a prospective study of 20 patients followed for one year who had presented with traumatic spinal cord injury involving initially acute neurological symptoms and cervical canal stenosis defined in the imaging by a Torg ratio<0.8 and a medullary canal ratio>0.65, without vertebral fracture., Results: Traumatic spinal cord injuries on cervical canal stenosis are caused mainly by falls in the elderly population and by unsafe behaviour among younger subjects. Most of the patients present with initially incomplete tetraplegia, and two thirds have centromedullary syndrome. Association of complete tetraplegia with advanced age would seem to be a predictive factor of death in the early post-traumatic period. For incomplete tetraplegics, the main phase of neurological and functional recovery is observed over the first six months. Radiological data and timing of surgery do not appear to affect the prognosis., Conclusion: This study underlines the need for individualized specialized care of patients with spinal cord injuries on cervical canal stenosis, particularly according to their demographic and lesional characteristics., (Copyright © 2011 Elsevier Masson SAS. All rights reserved.)

Cervical intradural disc herniation (IDH) is a rare condition and only 25 cases of cervical have been reported. We report a 45-year-old male who presented with sudden onset right lower limb weakness after lifting heavy weight. Magnetic resonance imaging of the cervical spine showed C5/6 disc prolapse with intradural extension. The patient underwent C5/6 discectomy through anterior cervical approach. Postoperatively, the patient improved in stiffness but developed cerebrospinal fluid leak and the leak resolved with multiple lumbar punctures.

This report describes a case of Brown-Sequard syndrome in a man who presented to the ED after a stabbing to the left scapula region. The incidental finding of pneumocephalus found on CT scan during workup lead to cervical MRI that revealed the spinal cord pathology associated with Brown-Sequard syndrome., (© 2011 The Authors. EMA © 2011 Australasian College for Emergency Medicine and Australasian Society for Emergency Medicine.)

Brown-Sequard syndrome (BSS) is a rare form of severe myelopathy characterised by a clinical picture reflecting hemisection of the spinal cord. This syndrome is mostly due to a penetrating injury to the spine but many other non-traumatic causes have been described. Intradural thoracic disc herniation (TDH) is one of the rare aetiologies of this syndrome. Despite progress in imaging techniques, diagnosis and treatment remain difficult. We retrospectively reviewed one of the largest reported series of six patients with BSS revealing intradural TDH between 2003 and 2007. There was a marked female predominance and the mean age was 44 years. Before surgery, half of the patients had a severe neurological deficit. The mean duration of symptoms until surgery was 8.5 months (range 0.5-24 months). Spine magnetic resonance imaging (MRI) or spine computer tomography scan showed calcified TDH between T5-T6 and T9-T10. The intradural location of the thoracic herniation was strongly suspected from the clinical data. All the patients underwent posterolateral transpedicular surgery with an operative microscope to open the dura mater. The intradural location of the herniation was overlooked in one case and the patient underwent a second procedure. The dura mater was carefully closed. Two patients' condition worsened immediately after the surgery before slowly improving. All the other patients improved their neurological status immediately after the surgery and at 12 months follow-up. BSS with TDH on the spine MRI scan may be a warning symptom of the intradural location of the herniated disc. In such cases, spine surgeons are advised to use an operative magnification and to open the dura mater to avoid missing this potentially curable cause of severe myelopathy.

Study Design: Case report., Objective: To describe a patient presenting with Brown-Séquard-plus syndrome treated in a conservative manner and to discuss the possible physiopathological mechanisms causing the injury., Methods: The case study of a 35-year-old woman who entered the hospital with a knife that had penetrated her neck through the left upper thoracic aperture and with a rising, back, right oblique trajectory. This patient developed Brown-Séquard-plus syndrome on the right side of her body., Results: The initial computerized tomography (CT) demonstrated that the tip of the knife was inside the right C7 vertebral foramen, which not dissected the vertebral artery. The initial magnetic resonance imaging (MRI) and the MRI done 3 weeks later showed the presence of spinal cord ischemia on the right side at the C6-C7 level. This spinal cord ischemia was most likely caused after a vessel spasm of the vertebral artery. After conservative treatment, the patient evolved from a C rating on the ASIA scale to a D rating., Conclusion: In our department, spinal cord injuries after stab wounds are very rare, and they usually cause incomplete lesions that eventually lead to Brown-Séquard syndrome. In our patient, the spinal cord injury was due to a vasospasm of the vertebral artery, which was accompanied by good functional prognosis. MRI helped to define the physiopathologic mechanism of the injury and guided the appropriate treatment decision.

Brown-Séquard syndrome is an uncommon condition involving incomplete spinal cord injury, with ipsilateral motor and proprioception loss, contralateral pain, and decreased temperature. Brown-Séquard-plus syndrome is associated with additional neurologic findings involving the eyes, bowel, or bladder. We describe an adolescent with Brown-Séquard-plus syndrome attributable to a stab injury. Our patient's clinical features of spinal and neurogenic shock overlapped at presentation. He was managed with high-dose steroids, along with intense physiotherapy and rehabilitation, resulting in good neurologic recovery. Appropriate medical (and surgical, when indicated) management usually results in good to complete recovery of neurologic function, depending on the level and grade of injury. With the increasing incidence of gunshot wounds and stab injuries in children, pediatricians, including pediatric neurologists and emergency physicians, are more likely to encounter these types of spinal cord injuries in children.

Study Design: Case report., Objectives: To present an unusual type of penetrating objects causing Brown-Séquard syndrome (BSS) and its clinical character., Setting: Department of Orthopaedic Surgery, Shanghai Changzheng Hospital, Second Military Medical University, Shanghai, PR China., Methods: A 54-year-old man fell from a height of 4 m onto an iron fence, and a sharp iron fence point penetrated the right side of his back. He developed left-sided BSS. Both X-ray film and computed tomography scanning of the thoracic spine showed a right vertebral plate of Th5 fracture and metal fragments inclining through the posterior and left lateral of the spinal canal. Emergency decompressive laminectomy and removal of the foreign metal piece were performed. No improvement in neurological function was observed 10 days after surgery, and thus hyperbaric oxygen treatment was initiated twice a day for the next 1 month., Results: Forty days after surgery, his bladder function returned to normal. The motor deficit had regressed and he could walk without assistance 70 days after the operation. One year later, his lower extremity functions recovered almost completely, except for slight numbness on the right side., Conclusion: As far as we know, on the basis of existing literature, the injury mechanism to BSS by a sharp iron fence point has not been reported so far. The satisfactory recovery after injury may in part be attributed to timely surgery and continuing hyperbaric oxygen treatment.

Study Design: A case report., Objective: To present a previously unreported cause of neurologic compromise after cervical spine surgery., Summary of Background Data: Several different causes of postoperative neurologic deficit have been reported in the literature. The authors present a case of acute postoperative paralysis after posterior cervical decompression by a mechanism that has not yet been reported in the literature., Methods: A 54-year-old muscular, short-statured man underwent posterior cervical laminectomy from C3-C5 without instrumentation and left C5 foraminotomy. Within hours of leaving the operating room, he began to develop postoperative neurologic deficits in his extremities, which progressed to a classic Brown-Sequard syndrome. Magnetic resonance imaging revealed regional kyphosis and large swollen paraspinal muscles impinging on the spinal cord without epidural hematoma. Emergent operative re-exploration confirmed these findings; large, swollen paraspinal muscles, a functioning drain, and no hematoma were found., Results: The patient was treated with immediate corticosteroids at the time of initial diagnosis, and emergent re-exploration and debulking of the paraspinal muscles. The patient had complete recovery of neurologic function to his preoperative baseline after the second procedure but required a third procedure in which anterior discectomy and fusion at C4-C5 was performed, which led to improvement of his preoperative symptoms., Conclusion: When performing posterior cervical decompression, surgeons must be aware of the potential for loss of normal lordosis and anterior displacement of paraspinal muscles against the spinal cord, especially in muscular patients.

Authors present case-report of young man with incomplete spinal cord injury after penetrating stab wound. Knife blade entered the skin in the level C3/4 in the back of the neck and directed to the right and downward. Both dorsal spinal cord columns and right half of spinal cord were transected. Neurological presentation was Brown-Séquard syndrome combined with dorsal columns syndrome. Wound revision was performed followed by dural closure. 18 month after injury significant neurological improvement of right hemiparesis was recorded and the patient is self-sufficient. Spinal cord stab wounds are rare. Typical clinical symptomatology is incomplete spinal cord injury. Clinical improvement of Brown-Séquard syndrome in our patient entirely corelates with literature.

Study Design: Case report and review of the literature., Objective: To report a patient presenting with Brown-Sequard syndrome due to cervical intradural disc herniation after spinal manipulation therapy., Summary of Background Data: Spinal manipulation therapy (SMT) is often used by people with neck pain or discomfort as an alternative therapy due to its claimed less invasiveness and comparable efficacy. However, excessive manipulations are reported to cause rare but serious complications such as tetraplegia, vertebral artery dissection, epidural hematoma, and phrenic nerve injury., Methods: Clinical history, physical examination, and radiographic findings of the patient were described. Anterior cervical discectomy at the C3/C4 level and interbody fusion with a Caspar plate-screw system for fixation, were performed., Results: A favorable surgical outcome was obtained. The Brown-Sequard syndrome improved and the patient regained full muscle power at a 3-months follow-up., Conclusion: Cervical intradural disc herniation after SMT is rare and most often cause Brown-Sequard syndrome. Definite diagnosis and prompt surgery usually achieves a satisfactory outcome. Anterior discectomy with interbody fusion is recommended. The OPLL associated with degenerative disc reminds us of the increased risk of intradural disc herniation. Those high-risk groups should be more cautious with spinal manipulation therapy due to its serious sequelae.

e report an 87-year-old woman who presented with incomplete Brown-Séquard syndrome after reactivation of varicella-zoster virus (VZV). Two days after herpes zoster in the right side of the chest, she developed weakness of the right lower limb. Neurological examination revealed a spastic palsy in the right lower limb and left side loss of pain and temperature sense to T6. However, vibration and position sense was not impaired in both sides. Spinal T2-weighted MR images showed a high-intensity lesion in the right side of the spinal cord except posL terior funiculus at the level of T2. Cerebrospinal fluid analysis showed 109 leukocytes/mm3, 79 mg/dl protein, negative VZV PCR, elevated titer of anti-VZV IgM and IgG, and increase of IgG index. Although she was treated with a combination of acyclovir and steroid pulse therapy, her weakness in the right lower limb was not improved. In this case, since the posterior funiculus circulated from the posterior spinal artery was not involved, the incomplete Brown-S6quard syndrome may be caused by spinal cord infarction due to VZV vasculitis of the anterior spinal artery.

Study Design: Case report., Objective: To present the second case of Brown-Sèquard syndrome (BSS) produced by type III odontoid fracture managed by conservative treatment., Summary of Background Data: The occurrence of BSS due to odontoid fracture is scarce. So far 6 cases have been reported, and only 1 is produced by type III odontoid fracture. The possible pathophysiology, clinical course and treatment outcome have been rarely discussed., Methods: A 39-year-old man presented with weakness of his left arm and leg, mild neck pain, and impaired proprioceptive and light touch sensations below the left C2 dermatome. There were decreased pain and temperature sensations below the right C4 dermatome too. Computerized tomography showed odontoid type III fracture with posterior displacement at that level. Magnetic resonance imaging presented focal hyperintensity around the C2 vertebral level. High dose of prednisolone, close reduction with Gardner-Wells tong skull traction, following external stabilization by Halo-Vest and rehabilitation therapy were applied., Results: Complete resolution of neck pain and significant improvement of motor and sensory functions, i.e., light touch and proprioception, were shown 2 months after spinal injury. Impaired temperature discrimination persisted, however., Conclusion: BSS is rarely caused by type III odontoid fracture and this is the second report. Conservative intervention is advantageous for both type III odontoid fracture and BSS which is consistent with previous results.

A 76-year-old female had suffered from distal arch aortic aneurysm and chronic DeBakey IIIB type dissecting aneurysm. The patient underwent thoracic endovascular aortic repair (TEVAR). After TEVAR the patient had a motor and proprioceptive loss on the left side and a pain and body temperature loss on the right side below the level of T7. At diagnosis of Brown-Sequard syndrome, corticosteroid and free radical scavenger were administered soon afterwards. Her neurological deficits gradually improved and the patient was discharged with the aid of a walking stick three months after TEVAR.

An 80-year-old woman with type 2 diabetes was admitted due to right-handed muscle weakness. The patient presented with Brown-Sequard syndrome, with complete paralysis of the right lower limb along with a loss of pain and temperature sensations in the left lower limb. Magnetic resonance imaging revealed a cervical epidural abscess, and accompanying edema or inflammation of the right side of the spinal cord at the C5 level. She underwent drainage and evacuation of the spinal abscess, followed by intravenous antibiotic administration. These interventions ameliorated the neurological deficits. The present case suggests the importance of epidural abscess as a rare pathogenetic cause of Brown-Sequard syndrome in type 2 diabetes.

Background Context: The risk of stroke because of carotid retraction during an anterior cervical spine surgery as well as the risk of bleeding complications after an anterior cervical corpectomy under deep anticoagulation and antiplatelet therapy is a surgical issue poorly addressed in the literature., Purpose: To describe the feasibility and safety of a simultaneous carotid endarterectomy and anterior corpectomy and fusion under deep anticoagulation in a patient with a cervical spinal cord compression and a severe carotid artery stenosis., Study Design: Case report., Methods: The authors describe the case of a 79-year-old man who had a 1-month history of progressive pain in the neck and left arm, associated with progressive weakness in the left arm and leg. He also presented a history of coronaropathy and bilateral severe carotid stenosis for which he was receiving a regimen of antiplatelet therapy., Results: The cervical magnetic resonance imaging demonstrated a C4-C5 disc herniation migrating down to C5. His condition worsened rapidly during hospitalization prompting a rapid decompression. Given the necessity of a C5 corpectomy and the risk of stroke during anterior cervical spine surgery, it was therefore decided to undertake the surgical procedure under efficient anticoagulant and antiplatelet therapy. A combined endarterectomy and spinal decompression and fusion were then performed. The postoperative course was uneventful, and the patient recovered neurologically., Conclusions: This case suggests that such a combined carotid endarterectomy and cervical corpectomy with fusion under anticoagulant and antiplatelet therapy is feasible. However, even if the unique clinical presentation of our patient led us to undertake such a surgical strategy, therapeutic decision in patients presenting with both severe carotid stenosis and cervical spinal cord compression should rely on a case-by-case analysis.

Background Context: Transdural spontaneous spinal cord herniation is a very rare nosological entity, which despite recent reports in the medical literature remains often misdiagnosed preoperatively. Usually it affects the thoracic segment, protrudes ventrally, presents clinically as a progressive Brown-Séquard syndrome and carries a favorable surgical outcome., Purpose: To describe a rare case of delayed recurrence of spontaneous spinal cord herniation despite excellent outcome for 10 years, and discussion of management and observation issues., Study Design/setting: Case report/University Hospital., Methods: We describe the management of a patient with spontaneous spinal cord herniation that presented initially with a Brown-Séquard syndrome and has been treated successfully with surgery. After 10 years free of symptoms, the patient developed progressive paraparesis and urinary incontinence because of recurrence of the herniation at the same level., Results: Despite technical challenges, during the second operation the enlarged ventral dural defect was meticulously closed and the patient's neurological condition presents 9-month postsurgery considerable improvement. To our best knowledge, recurrences of spontaneous spinal cord herniation are extremely rare., Conclusions: The reported case underlines the necessity to be aware of this rare but treatable spinal disease, notify the possibility of late recurrences and the need of long-term follow-up even if initial outcome is favorable.

Background: Spinal cord herniation through a dural defect is a cause of myelopathy and BSS that may be underdiagnosed. It may occur spontaneously, after trauma, or after surgery., Case Description: We present the case of a 47-year-old woman who presented with low back pain, progressive myelopathy, right proximal LEW, several episodes of falling, sensory changes below the lower part of the chest wall, and pathologic reflexes. Magnetic resonance imaging of the thoracic spine showed kinking of the spinal cord anteriorly at the level of T6-7. Posterior laminoplasty and intradural exploration revealed an anteriorly displaced spinal cord that was herniating through a ventral dural fold. The defect was repaired, and the spinal cord abnormality was reduced. Postoperatively, the patient's strength, gait, and sensation improved immediately., Conclusions: We discuss the successful surgical treatment of a thoracic spinal cord tethering from herniation through a ventral dural defect and review the literature regarding the proposed pathogenesis, surgical repair options, and reported outcomes.

Report of a case: A 60-year-old white male with a history of C3-C4 spinal cord injury with subsequent C3-C4 fusion complained of right upper extremity painful spasms of 2 years duration with associated hyperspasticity, motor weakness and poor positional and vibrational sense. The patient was diagnosed with Brown-Sequard syndrome (BSS) and treated with botulinum toxin type A injections distributed into the affected muscle groups that provided substantial and lasting relief. This case is unique in that the patient's trauma occurred 28 years before the development of the BSS suggesting a slow evolution of the condition.

A case presentation and discussion of a 32-year old male presenting an incomplete Brown-Séquard syndrome with Horner syndrome due to a plastic foreign body in the cervical medulla.

Background: Idiopathic spinal cord herniation (ISCH) is a rare cause of progressive myelopathy frequently present in Brown-Séquard syndrome. Preoperative diagnosis can be made with magnetic resonance imaging (MRI). Many surgical techniques have been applied by various authors and are usually reversible by surgical treatment., Methods: Case report and review of the literature., Findings: A 45-year-old woman with Brown-Séquard syndrome underwent thoracic MRI, which revealed transdural spinal cord herniation at T8 vertebral body level. During surgery the spinal cord was reduced and the ventral dural defect was restorated primarily and reinforced with a thin layer of subdermal fat. The dural defect was then closed with interrupted stitches., Results: Although neurologic status improved postoperatively, postsurgical MRI demonstrated swelling and abnormal T2-signal intensity in the reduced spinal cord. Review of the English language literature revealed 100 ISCH cases., Conclusions: ISCH is a rare clinical entity that should be considered in differential diagnosis of Brown-Séquard syndrome, especially among women in their fifth decade of life. Outcome for patients who initially had Brown-Séquard syndrome was significantly better than for patients who presented with spastic paralysis. Although progression of neurologic deficits can be very slow, reduction of the spinal cord and repair of the defect are crucial in stopping or reversing the deterioration.

We describe three patients with pre-ganglionic (avulsion) injuries of the brachial plexus which caused a partial Brown-Séquard syndrome.

Objective: Spontaneously occurring epidural hematoma without any identified etiology is a rare phenomenon. These are often neurosurgical emergencies; therefore, prompt diagnosis and treatment are paramount. Because of the rarity of this condition, we illustrated its presentation, evaluation and management in this recent case., Case: A 63-year-old male presented to our emergency room with right-sided hemiparesis and contralateral hypoesthesia, consistent with a C5 Brown-Sequard syndrome. An initial evaluation for cerebral infarction was unremarkable, including a negative brain computerized tomography imaging. Cervical magnetic resonance imaging (MRI) revealed a cervical epidural hematoma. The patient underwent emergent laminectomy for decompression and evacuation of the hematoma within 24 hours of presentation to the emergency room. The patient's symptoms improved remarkably after surgery and a 4th-month follow-up MRI evaluation was normal., Conclusion: This report highlights the various presentations, evaluation, and management options for this rare diagnosis. It emphasizes the necessity of prompt diagnosis for possible emergent intervention.

Summary: The spontaneous occurrence of acute Brown-Séquard syndrome is an extremely rare event, with most reported cases being secondary to spontaneous epidural hematomas and spinal cord ischemia. We report a rare case of Brown-Séquard syndrome from spontaneous intraspinal hemorrhage in a patient with multiple cavernous angiomas in the spinal cord secondary to craniospinal radiation in childhood. Postulated mechanisms leading to the condition include postradiation molecular changes and venous occlusion.

Object: The authors report on a series of 10 patients with spontaneous thoracic cord herniation, provide the longterm follow-up, and propose a surgical strategy., Methods: All 10 patients had a defect in the ventral dura mater. They were all treated surgically with wide excision of the dura around the defect, repositioning of the cord, and reconstruction with a ventral patch. Five patients were followed up for > 4 years., Results: Surgery improved motor power in 4 patients and pain in 2 patients, although sensory disturbances remained unchanged in all but 1 patient. One patient's condition deteriorated secondarily due to edema and syringomyelia., Conclusions: Microsurgical treatment may halt the exacerbation of neurological symptoms and should be performed with progressive deficits. Long-term results are good regarding the motor function.