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Challenges in trauma and acute care surgery
Brown-Sequard syndrome
  1. Eliza Moskowitz1,2,
  2. Thomas Schroeppel1
  1. 1Department of Surgery, Memorial Hospital Colorado Springs, Aurora, Colorado, USA
  2. 2Trauma and Acute Care Surgery, University of Colorado School of Medicine, Denver, Colorado, USA
  1. Correspondence to Dr Eliza Moskowitz; eliza.moskowitz{at}ucdenver.edu

https://doi.org/10.1136/tsaco-2018-000169

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    A 67-year-old otherwise healthy woman was assaulted with a knife, receiving multiple stab wounds. On arrival, vital signs were within normal limits. She was mentating appropriately. She complained of weakness to her right upper and lower extremities. Neurologic examination demonstrated 0/5 right triceps and grip strength to the right upper extremity and 0/5 motor strength throughout the entire lower extremity. Right sensory examination demonstrated hypesthesia at C7, anesthesia at C8 and T1, with hyperpathia T2 fading through the upper lumbar levels associated with complete proprioceptive loss. On the left, there was anesthesia at T4 and hypesthesia at T5 fading through the upper lumbar levels with retained left proprioception. Back examination demonstrated a 1 cm laceration to the left of midline at C7 with clear fluid leaking from the wound. MRI demonstrated abnormal signal at the C5–C6 level, consistent with traumatic injury secondary to stab wound.

    Parasagittal  short -T1 inversion recovery (STIR) MRI  (figure 1) spinal cord hemisection at C6. Remaining portions of the imaged spinal cord  …

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