Disclosures: Stephen W. Peirce, MD: Nothing to disclose

Case Description: Previously healthy male presented after sustaining gunshot wound to his left scapula which traversed through his neck. He had a severe tracheal injury requiring emergent reconstruction and tracheostomy. Once stabilized, he was found to have no sensation from nipple line and below and no movement of the lower extremities. Spinal imagery showed T1-T2 left facet fracture and T2 vertebral body fracture as well as C7-T3 spinal cord infarct.

Setting: Inpatient rehabilitation facility.

Patient: An 18-year-old male with Brown-Séquard syndrome.

Assessment/Results: On admission to rehab, he was aphonic and dysphagic with bilateral lower extremity paresis and spasms. He worked intensively with physical, occupational, and speech therapy for 31 days. Aquatic therapy and Lokomat gait training was found to be especially beneficial to patient’s recovery. Full ASIA examination was performed and patient was found to have hemi-cord injury originating at his left T4 resulting in weakness with lack of proprioception and vibration on left lower extremity, absent pinprick and temperature from T4 to S5. By discharge, his Functional Independence Measure score approached 5-6 with functional ADLs.

Discussion: True Brown-Séquard syndrome is rare as it requires a lesion to only one half of the spinal cord. This results in paralysis and loss of proprioception on the ipsilateral side of the lesion and loss of pain and temperature on the contralateral side. This patient presented with a GSW that was not in the immediate vicinity of the spinal cord, however due to vascular injury, led to an ischemic infarction of the left half of his spinal cord. This was not originally distinguished as his injury was masked by spinal cord inflammation but with resolution his diagnosis was readily identified.

Conclusion: This is a relatively well understood but rarely observed syndrome. This atypical presentation reinforces the importance of a thorough patient history and continued physical examination to correctly identify diagnosis.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/brown-sequard-syndrome-secondary-to-ischemic-spinal-cord-infarction-a-case-report/