Disclosures: Varun Y. Goswami, MD: Nothing to disclose

Case Description: A 26-year-old male with no past medical history presented with right sided weakness and left sided sensory loss post gunshot wound. The bullet traversed through the post-auricular area bilaterally. Angiogram revealed a comminuted fracture of the posterior arch of C1 without bony central canal stenosis. Cervical spine magnetic resonance imaging demonstrated an acute ballistic injury with extensive posterior paraspinal edema centered at the level of C1, intact ligamentum flavum, and no anterior ligamentous injury. Neurosurgical evaluation stated no evidence of cervical cord compression, deeming cord injury to be secondary to blast injury.

Setting: Inpatient Rehabilitation Facility

Patient: A 26-year-old male with right sided hemiplegia.

Assessment/Results: Upon admission to inpatient rehabilitation, patient presented with impairments with sensory functions including touch, strength, balance, and motor control. Physical exam revealed right sided hemiplegia with loss of proprioception and left sided sensory loss with preservation of motor function consistent with a diagnosis of Brown-Séquard-plus syndrome. He worked intensively with physical therapy and occupational therapy for four weeks, significantly benefiting with locomotor gait training and neuromuscular re-education. Initially, patient required a power wheelchair for mobility. By discharge, he was able to ambulate 75 feet with moderate assistance using a rolling walker. Discharge physical exam showed improvement from flaccid right sided hemiplegia to anti-gravity strength.

Discussion: The presence of pure Brown-Séquard syndrome is very rare. A clinic picture of fragments of the syndrome is more common. Symptoms often include ipsilateral hemiparesis or hemiplegia with loss of proprioception and vibration sensation below the level of the lesion, with contralateral hemianesthesia two levels below the lesion. Prognosis for significant motor recovery is favorable with aggressive therapy.

Conclusion: Brown-Séquard-plus syndrome very rarely occurs due to blast injury. It is imperative to remember blast forces have the potential of disrupting the spinal cord due to shear forces.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/a-rare-case-of-ballistic-injury-causing-brown-sequard-plus-syndrome-a-case-report/