Brown-Sèquard-Syndrome (Nursing)

00:01 Now this one is a fascinating syndrome, Brown-Sequard Syndrome.

00:05 It is named after the gentleman who first discovered it in about 1850.

00:11 Now it's a relatively rare type of partial paralysis so you may not even get to see one of these unless you're in a really specialized unit.

00:19 Now, sometimes it's referred to Brown-Sequard hemiplegia or Brown-Sequard paralysis but it's paralysis on one side of the body and loss of sensation on the other -- it's really weird, so they can't feel like pain or temperature on the other side of the body.

00:36 So before we go forward, Brown-Sequard is loss of sensation on one side of the body and loss of movement on the other side of the body.

00:47 Usually it's caused by some sort of type of damage to the spinal cord.

00:51 So, let's look at like -- usually the spinal cord is damaged by a puncture wound or something on the right side, if that happens, then the patient will have paralysis on the right side of the body and sensation loss on the left side of the body.

01:07 Now we're trying to show you this with a graphic there.

01:10 You see this is a very high level of injury.

01:13 Now, the shaded areas are what show you what was injured so the head injury on the right side of the body they'll have loss of movement on the right side of body of the core damage but they'll have a loss of sensation on the left side, that's what Brown-Sequard syndrome is.

01:30 Now we talked about causes like the puncture wound but usually it can often be seen with a spinal cord lesion and that's what cause the damage but it doesn't sever the cord completely.

01:41 Some other causes you would consider, spinal cord trauma especially puncture or gunshot wounds or a spinal cord tumor.

01:49 So, how I remember Brown-Sequard syndrome is Brown-Sequard has two names, that helps me remember, oh, on the side of the injury I have one loss and on the other side I'm gonna have the opposite so I have loss of movement, loss of sensation, the two sides are different and I also remember two predominant reasons for that, spinal cord trauma or spinal cord tumor? So that helps me keep it straight in my mind.

02:15 Now it could also assume other problems with that if blood supply is cut off or an obstructive blood vessel that could cause it and there are some other diseases like multiple sclerosis and meningitis.

02:26 So those are some challenges but to help my brain remember, two names, I remember, two sides and the top two reasons would be trauma or tumor.

02:37 Now with this you always have to treat the underlying cause.

02:42 You have to diagnose what causes to have this two-sided syndrome and it's usually done with an MRI or what we call magnetic resonance imaging.

02:50 Now treatment options usually very depending on what caused it.

02:54 You know, if it was a tumor we need to remove it, if it was an injury we need to address that.

02:58 Usually high dose steroids early on will help and start to show some success, but, remember, you've got to figure out what that underlying cause is and resolve that.

03:07 Remove the tumor, deal with the bullet, do the other injury, whatever needs to be done to treat the underlying cause; but these patients will most likely receive some pretty high doses of steroids.

03:18 Okay, here's a little spinal cord trivia for you.

03:21 Let's see if you can remember where in the vertebral column does the spinal cord end? Whoa, no peeking. Pause the video and make sure that you write down your answer.

03:32 Give it a guess even if you're not sure. We'll come back and walk through the right answer.

03:37 Okay, what was your guess? Well, let's talk about it. In the adult, the lower end of the spinal cord usually ends at approximately the first lumbar vertebra so we call that at L1, that's where it divides into these many little individual nerve roots, so that's the reason if a health care practitioner is doing a lumbar puncture, they usually go the level between L3 and L4 because obviously we wouldn't want to puncture the spinal cord.

04:05 So it ends at L around L1 in an adult that's why we do a lumbar puncture between L3 and L4.

04:13 Now one last piece of spinal cord trivia, the point where the spinal cord ends is referred to as the conus medullaris.