Trigger 2SUMMARY

Hemisection of the spinal cord (Brown Sequard Syndrome)

Trigger 2 Mr. Y, 40 years old, was in a traffic accident

and was taken to the Emergency unit. The patient was still conscious but could not walk unaided. Paralysis cover his right arm and legs. On examination, a hematoma was found on the back of his neck. He could not feel any sensation of pain on his left starting from his foot up to the base of his neck. Physical examination revealed right biceps reflex and right patellar reflex were negative. The pupil of his left eye was constricted, with ptosis and enophthalmus.

Keywords:

Paralysis of the right side of the body Loss of pain sensation of the left side

of the body, starting from the neck down.

Right biceps reflex and right patellar reflex were negative.

Pupillary constriction, ptosis, and enophthalmus of the right eye

Where is the probable site of lesion in the nervous system??

According to the dermatom area, the patient got loss of sensation up to segment C3 of dermatom (Base of the neck is C2-3) .Thus, the probale site of the lesion is on C3 or bellow C3 segment of the spinal cord.

Since the paralysis is on the right side, the lesion must be on the right section of the spinal cord (look at the picture)

The injured tracts :

Sensory: Spinothalamic

tract (pain, temperature, touch, pressure) from the left side of the body

Fasciculus gracilis dan cuneatus (proprioception and discriminative touch) from the right side of the body

Spinothalamicus

Fasciculus gracilis dan cuneatus

MOTOR: Lower motor neuron

in the area of the lesion eg. C5-6 that innervate biceps muscle.

Corticospinal tract (UMN axon) that will end in spinal cord segment bellow the lesion

LMN

LMN

UMN

Muscle paralysis: LMN paralysis : LMN in the spinal cord at

the level of the lesion (C3,4,5,6..) C3-4 innervate diaphragm breathing difficulty C5-6 innervate biceps flaccid paralysis, reflex

(-) UMN paralysis : affected the corticospinal

tract (UMN axons) that will end in the spinal cord segment bellow the lesion spastic paralysis. Patellar reflex :

Negative : due to spinal shock (0-1 day) positive: 1 – 7 day Hyperreflex : 1-4 week spasticity

Two point discrimination (using calipers) :

Left side of the body can differentiate two point

Right side of the body cannot differentiate two point

Horner syndrome : Lesion on sympathetic fibers which

innervate the head region. Preganglionic neuron : intermediolateral horn of

the T1 segment of the spinal cord Postganglionics neuron: superior cervical

ganglion Pupillary constriction: due to paralysis of

the dilator muscle of the eye Pseudoptosis : due to paralysis of the

levator palpebra superior muscle (smooth muscle part)

Enophthalmus: due to narrowing of the palpebral fissure (not true enophthalmus)