Disclosures: Yevgeniya Sergeyenko, MD, MPH: Nothing to disclose

Case Description: The patient presented to the trauma bay in cardiac arrest status post two gunshot wounds to the neck, including zone III of the left neck and right cervical paraspinal region below the occiput. Return of spontaneous circulation was achieved. Imaging revealed a left C2 laminar fracture with bony fragments and air within the spinal canal at C2 and cord signal change consistent with blast injury, worst on the left at C1-C2. There was no vascular compromise. The patient underwent C1-C3 posterior fusion. Manual muscle testing showed 5/5 strength throughout his right lower extremity and 2/5 strength in his right upper extremity. His left side was 0/5 strength throughout. Sensation to pinprick and light touch on the right was disrupted in all dermatomes. On the left, there was some preserved sensation to pinprick and altered light touch sensation in the thoracic region. Voluntary anal contraction and deep anal pressure were intact. Initial ISNCSCI exam was C1 AIS C.

Setting: Level 1 Trauma Center

Patient: Previously independent 31-year-old male without significant past medical history

Assessment/Results: Prior to surgery, the patient was plegic in his bilateral upper and left lower extremities. After C1-C3 posterior fusion, he began regaining strength in his right upper extremity. Additionally, he weaned off the ventilator despite his high cervical level of injury.

Discussion: This patient presented with ipsilateral hemiplegia and contralateral impaired pinprick sensation, consistent with Brown-Séquard syndrome. He also had diminished strength in the right upper extremity with additional sensation loss outside of what would be expected with a pure Brown-Séquard syndrome. The patient’s bilateral upper extremity weakness was consistent with Central Cord syndrome.

Conclusion: Brown-Séquard syndrome is a rare spinal cord injury pattern, unlikely to present in its pure form. This patient provides an interesting case, presenting as a combination of Brown-Séquard and Central Cord syndromes.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/traumatic-high-cervical-spinal-cord-injury-presenting-as-an-intersection-of-brown-sequard-and-central-cord-syndromes-a-case-report/