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Acute Brown-Sequard Syndrome

David Gill, MD; Sarah Ifthikharuddin, MD; Lawrence M. Samkoff, MD
Arch Neurol. 2004;61(1):131. doi:10.1001/archneur.61.1.131.
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A 71-year-old, right-handed woman had right shoulder pain of sudden onset, with radiation into the forearm and hand, rapidly followed by weakness of her right arm and leg. She had no speech difficulty, facial weakness, or neck pain. An emergency head computed tomographic scan showed no abnormalities. The findings of our general examination were unremarkable; there was no neck tenderness or cervical bruit. A neurologic examination was significant for right hemiparesis (2/5), decreased vibration and proprioception in the right foot, diminished pain and temperature to the left C6 level, and a right Babinski sign. Routine laboratory analysis results, including a coagulation profile, were normal. Magnetic resonance imaging of the cervical spine revealed a right C4 through C7 spinal epidural hematoma (Figure 1) with spinal cord compression. The patient underwent an emergent operation to evacuate the clot. No structural source of hemorrhage was found at the surgery. Postoperatively, the patient's condition slowly improved, and she was transferred to a rehabilitation unit for further treatment.

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A, Sagittal T1-weighted magnetic resonance image of the cervical spine reveals an isodense to intermediate-hyperintense posterior epidural mass extending from C3 through C7, with spinal cord compression corresponding to a subacute epidural hematoma (arrow). B, T2-weighted axial scan demonstrates a hematoma (arrow) as a heterogeneously hypointense mass in the right posterior epidural space, with spinal cord distortion. No contrast enhancement was seen after injection of gadolinium.

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