Attending Physician St. Charles Hospital/CHSLI Port Jefferson, New York, United States
Case Diagnosis: 45-year-old male with history of chronic back pain who developed worsening pain, interfering with ambulation and ADLs. He was unable to ambulate for more than thirty minutes. MRI demonstrated a large calcified T8-T9 disc herniation with spinal cord compression. After failing conservative therapy, patient underwent T8-T9 thoracic discectomy. Had intraoperative loss of motor and sensory signals on neuro-monitoring to bilateral lower extremities. Post operatively, treated with dexamethasone and had a catheter placed for neurogenic bladder. Hospital course complicated with hypotension requiring pressor support. On discharge to acute rehabilitation, patient had no motor function in the right lower extremity and continued to have sensory deficits.
Case Description: Upon rehabilitation admission, patient was found to have flaccid RLE. LLE strength 3-4/5. Decreased pain/temperature sensation in LLE. Decreased proprioception of RLE. Patient had progressive improvement in tone and muscle strength of the right lower extremity. Therapy focused on functional mobility with gait training, transfers and bed mobility. Trained in donning and doffing of KAFO to RLE and demonstrated ability to ambulate 45 feet with rolling walker. Catheter was discontinued as neurogenic bladder improved. After discharge home, patient followed up with outpatient therapy and continued to have functional improvement.
Discussions: Brown-Séquard Syndrome is caused by a relative hemisection of the spinal cord, most commonly from penetrating trauma. It has been described in cases of post epidural hematoma, abscess, and tumor in the spinal cord. Cases of post-surgical discectomy have been rarely described in literature.
Conclusions: Brown-Séquard syndrome has shown to have good motor and neurological recovery of the involved levels. Markers of good motor outcome include progressive improvement with hip extension and ankle dorsiflexors. Literature review also shows good outcome and neurogenic bladder recovery as we observe in this case.