Brown-Séquard syndrome after a gun shot wound to the cervical spine: a case report.
BACKGROUND
Brown-Séquard syndrome is characterized by a hemisection of the spinal cord most commonly after spinal trauma or neoplastic disease. The injury causes ipsilateral hemiplegia and proprioceptive sensory disturbances with contralateral loss of pain and temperature sensation. Patients with Brown-Séquard syndrome have the best prognosis of all spinal cord injury patterns. At this time, the ideal management for Brown-Séquard syndrome after penetrating trauma has yet to be defined.


OBJECTIVE
To report a case of a gun shot wound to the upper cervical spine that resulted in Brown-Séquard syndrome and was treated effectively with early cervical spine decompression and fusion.


METHODS
Observational case report.


METHODS
A 28-year-old woman presented after sustaining a low-velocity gun shot wound in to the upper cervical spine in a civilian assault. On initial presentation, she had 0/5 motor scores in the left upper and lower extremities and normal motor scores on the right. Sensory examination was limited as she was intubated and sedated on admission due to airway compromise. A computed tomography scan revealed a bullet lodged in the vertebral body of C3 with boney fragments and soft tissue encroaching on the spinal cord. Subsequently, she underwent C3 corpectomy, bulletectomy, and anterior cervical decompression with fusion.


RESULTS
Intraoperatively, no dural disruption or cerebral spinal fluid leak was noted, and her posterior longitudinal ligament was intact. One month postoperatively, her left lower extremity motor score was 5/5 with movement of her left thumb and all fingers. Strength in her biceps, triceps, and wrist extensors and flexors was 3/5. Her functional capacity and strength gradually improved.


CONCLUSIONS
Reinke et al. support surgical intervention for patients with incomplete paraplegia after the patient is medically stabilized, although their case report discussed lower thoracic injury, which carries a more favorable prognosis. All other prior case reports and prospective studies that reported favorable outcomes after Brown-Séquard syndrome involved the midthoracic, low thoracic, or lumbar spinal levels. This report is the first case of Brown-Séquard syndrome after a high cervical gun shot wound, which was managed with immediate decompression and fusion, where near complete recovery was obtained.
Department of Orthopaedic Surgery and Rehabilitation Medicine, SUNY Downstate Medical Center, 450 Clarkson Ave., Box 30, Brooklyn, NY 11203, USA.
Dante
D
Leven
Ali
A
Sadr
William R
WR
Aibinder
D000328:Adult; D018437:Brown-Sequard Syndrome / Q000000981:diagnostic imaging / Q000209:etiology* / Q000601:surgery*; D002574:Cervical Vertebrae / Q000000981:diagnostic imaging / Q000293:injuries / Q000601:surgery; D019299:Decompression, Surgical; D005260:Female; D006801:Humans; D011859:Radiography; D020127:Recovery of Function; D013119:Spinal Cord Injuries / Q000000981:diagnostic imaging / Q000209:etiology* / Q000601:surgery*; D013123:Spinal Fusion; D014948:Wounds, Gunshot / Q000150:complications* / Q000000981:diagnostic imaging / Q000601:surgery
Brown-Séquard syndrome; Cervical cord; Gun shot wound; Spinal cord trauma