Examine this patient's neurological system.
· Weak leg which feels normal whereas the other leg is moving perfectly but the patient has no sensation for pain andtemperature.· Trauma to the spine, e.g. stab injury.· Tell the examiner that you would like to take a history for bladder and bowel symptoms.· History of degenerative spine disease or multiple sclerosis.
· Deficits below the level of the lesion include:-Ipsilateral monoplegia or hemiplegia.-Ipsilateral loss of joint position and vibration sense.-Contralateral loss of spinothalamic (pain and temperature) sensation. The latter is sometimes localized to one or two segmentsbelow the anatomical level of the lesion.· Deficits in the segment of the lesion:- Ipsilateral lower motor neuron paralysis.-Ipsilateral zone of cutaneous anaesthesia and zone of hyperaesthesia just belowthe anaesthetic zone.-Segmental signs such as muscular atrophy, radicular pain or decreased tendonreflexes are usually unilateral.· Tell the examiner you would like to examine the spine and exclude multiple sclerosis.
This patient has Brown-Sequard syndrome (or hemisection of the spinal cord) at the level ofT8 (lesion), probably due to acompressive or destructive lesion of the spinal cord (aetiology). The patient is limited by the weakness in one limb (functionalstatus).
What are the causes of hemisection of the spinal cord?
· Syringomyelia.· Cord tumour.· Haematomyelia.· Bullet or stab wounds.· Degenerative disease of spine.· Multiple myeloma.Charles-Edouard Brown-Sequard (1817-1894) was Professor of Physiology in Virginia, USA, at the National Hospital, Queen Square, London, atHarvard, and finally in Paris. He was the first physician-in-chief of the National Hospital in Queen Square which was founded in 1860. In 1889 he issaid to have drawn much attention and criticism for injecting himself with a testicular extract (BMJ 1889; 1: 1416). Several nations lay claim toBrown-Sequard: he was born in Mauritius, then a British colony, the son of a French woman and an American sea captain (Lancet2000; 356: 61-3).