Brown-Séquard-plus syndrome after a stab injury.
METHODS
Case report.


OBJECTIVE
To describe a patient presenting with Brown-Séquard-plus syndrome treated in a conservative manner and to discuss the possible physiopathological mechanisms causing the injury.


METHODS
The case study of a 35-year-old woman who entered the hospital with a knife that had penetrated her neck through the left upper thoracic aperture and with a rising, back, right oblique trajectory. This patient developed Brown-Séquard-plus syndrome on the right side of her body.


RESULTS
The initial computerized tomography (CT) demonstrated that the tip of the knife was inside the right C7 vertebral foramen, which not dissected the vertebral artery. The initial magnetic resonance imaging (MRI) and the MRI done 3 weeks later showed the presence of spinal cord ischemia on the right side at the C6-C7 level. This spinal cord ischemia was most likely caused after a vessel spasm of the vertebral artery. After conservative treatment, the patient evolved from a C rating on the ASIA scale to a D rating.


CONCLUSIONS
In our department, spinal cord injuries after stab wounds are very rare, and they usually cause incomplete lesions that eventually lead to Brown-Séquard syndrome. In our patient, the spinal cord injury was due to a vasospasm of the vertebral artery, which was accompanied by good functional prognosis. MRI helped to define the physiopathologic mechanism of the injury and guided the appropriate treatment decision.
Department of Physical Medicine and Rehabilitation, Hospital La Fe, Valencia, Spain.
Manuel Giner
MG
Pascual
Vicente Sebastiá
VS
Alcácer
Maria Victoria Perez
MV
Pomares
Modesto Alcanyis
MA
Alberola
D000328:Adult; D018437:Brown-Sequard Syndrome / Q000209:etiology* / Q000503:physiopathology*; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D013119:Spinal Cord Injuries / Q000150:complications*; D014057:Tomography, X-Ray Computed; D014951:Wounds, Stab / Q000150:complications*