Brown-Séquard´s syndrome (spinal hemiplegia) and calcified cervical disc herniation

Brown-Séquard´s syndrome (BSS) is an unusual clinical entity caused by damage to one half of the spinal cord mimicking a classic hemiplegia. This syndrome is characterized by ipslateral loss of motor function (paralysis), proprioception, and vibratory sensation, combined with contralateral loss of pain and temperature sensation. Spinal cord injuries and tumoral diseases were the most frequent etiologies associated with BSS. Spontaneous cervical disc herniation has rarely been considered. This 49-year-old man, previously healthy, presented with a two-year history of progressive left arm and leg paresis associated with decreased pain and thermal sensitivity in the right hemibody below the C5 dermatoma without bladder or bowel complaints. There were bilateral extensor plantar responses. Brain computed tomography (CT) scan performed at another institution was normal. Spinal cervical magnetic resonance imaging and CT-scan showed a voluminous calcified cervical disc herniation at C4-C5 vertebral level (arrows) with marked compression of the left half of spinal cord. A complete surgical spinal cord decompression was performed by an anterior cervical approach with interbody fusion. There was a partial recovery of neurological status after a long time of physical rehabilitation. In some incomplete forms of BSS, hemiplegia or hemiparesis may be confused with those caused by brain damage as seen in our patient. Accordingly, the diagnosis is further delayed. Spinal MRI should be employed early in the diagnostic evaluation of such patients. In addition, cervical disc herniation should be considered in the differential diagnosis of BSS, even in the absence of the typical symptoms.