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Brown Sequard? Sci Nurse or Dr.Young?

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  • Brown Sequard? Sci Nurse or Dr.Young?

    In the 10 weeks since my husband injury he has been getting some good return. However, he tells me that the return he's getting has some of the nurses/doctors stumped. I know that doctors sometimes get frustrated with patients who self diagnose by researching the internet, but from what I've read it sounds to me like he is showing signs of having Brown-Sequard Syndrome. When he brought this up to one of the residents on his team they just brused him off and said that Brown Sequard typically only happens with puncture wounds. I swear that I have also read that it can occur in some blunt force trauma as well...? My husband had a dirt bike smash into the back of his head when he fell during a motocross race which resulted in a C6 burst fracture. Originally the neurosurgeon told us that he had 80% compression from one of the larger broken pieces and didnt appear to have any part of the spinal cord cut or severed. He also had compression to his vertebral artery.

    Can you please give me your thoughts on this? He was originally classified by his rehab facility as a C5 sensory incomplete, Asia B. About 2 weeks ago they updated him to a Incomplete, Asia C. He has recovered both triceps - left one shows more than his right; his index finger and thumb on his left hand, his left hip flexor, his left hamstring, his left calf muscle, and he can wiggle all the toes on his left foot. Other than his tricep on the right side he has not gained any other motor function BUT he has better feeling on this side. He can feel the needle when the give him his shot on the right side of the stomach, but only feels pressure if they give it to him on the left side. He can tell the difference between the sharp end of a safety pin and the blunt end on the entire right side of his body. On his left side, he can only feel the sharp end above his injury level and some parts of his abdomen and a few random spots (like behind his knee?) but can only tell that he's being touched when you pin prick the rest his legs and feet. I know I shouldn't get wrapped up in syndromes, or the Asia scale but I am honestly to a point where I am fascinated by this and I'd really like to hear your thoughts, opinions.

  • #2
    I have a friend who has a brown sequard injury from an RTA. His wasn't a puncture injury either, he broke a vertebrae, I'll ask him to take a look at this when I finish work. He's about a year and a half post injury. Everyone is unique, so he might help give you an idea of what to expect, but it's really just a case of 'wait and see'.

    Best wishes to you both, stay positive.
    T11 Asia A after near-fatal bike crash.. Just happy to still be here

    No, I didn't loose my mind... It got scared and ran away!!


    • #3
      While it is more common to see BSS injuries in penetrating injuries of the cord (GSW, stab, etc.) it is also fairly common to see them with rotational types of injuries in motorcycle or car accidents (for example). They are not common in falls.

      Where is your husband?? Is this a SCI specialty rehab center? Is his physiatrist a specialist in SCI?? Can you get a copy of his most recent ASIA (now called the ISNCSCI) exam???

      The SCI-Nurses are advanced practice nurses specializing in SCI/D care. They are available to answer questions, provide education, and make suggestions which you should always discuss with your physician/primary health care provider before implementing. Medical diagnosis is not provided, nor do the SCI-Nurses provide nursing or medical care through their responses on the CareCure forums.


      • #4
        Thank you guys for your quick responses!

        My husband is currently at NRH in DC (National Rehabilitation Hospital) and they do specialize in SCI, among a few other things. His physiatrist is a specialst in SCI, and she does meet with my husband once a day but he speaks a lot with the residents that are under her. I haven't heard his main doctors response to this question yet, but she typically doesn't jump to any sort of diagnosis. Which, I guess can either be a good or a bad thing. When I asked about the syndromes in our first family meeting 2 months ago when he first got there I was told not to read into these things too much yet. It's really hard not to though.

        I'm pretty sure I could get a copy of his most recent ASIA exam, what would I be looking for with this though? Do they typically put these types of diagnosis in these exams?

        I honestly cannot tell you how much I appreciate all of the help and information I get from this website. I walk into our family meetings loaded with questions and have stumped his team several times with some of the things that I have learned from this site and from Dr. Young.


        • #5
          hi, i am simon's friend from above and i have brown sequard asia c/d at c4 level and it sounds like you are in a very similar situation to where i was back at 13 weeks. My injury was also the result of a blunt impact in a traffic accident and i ended up at first completely paralysed from the shoulders down for around 4 weeks, fortunately after that stage i did then start to get some movement return after that but it was very slow and steady, as im sure you know brown sequard is an uncommon and difficult condition to grasp but in my experience after a while you do get to grips with it, i remember spending hours online on forums and being no closer to understanding it fully than when i first started looking, my good movement side is my right side i have full movement in both my right arm and leg but bad sensation now everyone with the condition is different and some peoples sensations are effected slightly differently but for me i can not feel pain, hot or cold, wet or dry ,or light tough on the skin at all! now although this sounds daunting but i have gotton completely used to it and i forget its even like it sometimes, but as a word of advice for your husband as he starts getting more function-ability back is to take care with these problems!
          they should not change his ability to use the limbs at all but it always needs thought such as when taking showers to test the water on your weak muscular/good sensation side first and avoid holding cups of tea,hot plates etc before testing it with your weaker arm first , after 6 months or so it should be effortless and he'll be doing it without even thinking too much about it lol, now my weak muscular side ( left side) has good sensation almost 100% normal, but is very weak, my left arm has no tricep at all so for your husband to have some at all is good ! especially for weight baring through the arms, my left hand still has no finger dexterity but is still improving over a year on, my left leg is slightly stronger but still weak, i can not pull up the foot ( drop foot) so i wear an AFO under my jeans for walking , i can currently walk on crutches but only recently a year and a half on that really been getting good. i hoped this helped and wasn't too boring lol one more thing i must say with brown sequard is dont stop trying to move stuff ! keep working at your fingers etc else the nerves wont just do it all for you, if you have ay questions please feel free to ask and i wish you and your husband the best of luck recovering


          • #6

            Thank you so much for all of the great information!! I think checking the temperature with the weaker side would definitely be something that he would have to get used to. He was right handed before his accident, and that is his weaker side so right now he tends to use that to check temp and I'm hoping he continues to do that. Did your doctors diagnose you as BSS or were you a self diagnosis as well?

            As I suspected, his main doctor told him this evening that he does not have BSS. My husband told me that the explanation he got from her was that it typically only comes from stab wounds, etc. just like the resident told him this morning. I know in the scheme of physical therapy and occupational therapy this may not change what he works on, but I can't help but feel a little irritated. I definitely know that the doctors know more than I do, but my husband's return mirrors everything i've read about BSS. I guess I just get a little frustrated at constantly feeling like I'm being dismissed when I want to know things like this. Or maybe I actually am the confused one, can you have an incomplete SCI and not have one of the incomplete syndromes?


            • #7
              I'm a T4,5,6 incomplete and when I started getting some return back my doc said that my return was similar to someone with BSS. I was in an auto accident and had no punctures. I regained about 95% sensation on my rightside below my injury but no movement and in some area's I even have hyper sensation like behind my knee. As for my leftside, I only regained about 5% at most sensation below my injury but I can move my toes and foot as well as stand on my left leg with help. The sensation I regained on my left side is spotty, like I have an area on my side that I can feel but have no feeling above or below the area. As far as bowel and bladder, I know when I need to go I just can't go on my own. I did get 98% of the "Loving Feeling" back also.

              Good Luck to you and your husband.

              SCI Birthday: April 25, 1993
              T4,5,6 Incomplete
              Chair: TiLite TR3


              • #8
                i was self diagnosed, my doctors at the hospital i went to were very dismissive as to what i had until i went to a spinal rehab unit where the doctors were more directly skiled in spinal injuries but its hard for anyone to tell exactly because no two people damage the same place in the same way and everyone has different returns in function in te end i guess it doesn't make a difference but the terminology just helps understand whats going on it certainly sounds like bss


                • #9
                  My husband has this too. He broke c6 in a skiing accident in March 2001; it was July before anybody said the words "Brown Sequard" to us, and that was in an outpatient followup visit. I'd never heard of it. Short history:

                  Night of injury: diagnosis was "complete"
                  Next day: anal sensation
                  Two weeks post: flicker of movement in left toes
                  Ten + weeks discharge: lots of (very, very weak) muscle return on left side, very little on right
                  Two years of PT later, able to struggle along behind a walker for a fifty yards

                  11 years later: he walks everywhere with a cane, has full use of left hand.

                  What I understand is that Brown Sequard is a kind of MAYBE ticket . . . you have a shot, is what the doctor who diagnosed it said to him. You have a chance to get out of that chair. It seemed just impossible at that time, and would have been without all those very focused and talented PTs, and one hell of an investment in both time and money, not to mention effort.

                  Good luck to you ~ ask questions and don't take no for an answer.


                  • #10
                    I have BS syndrome and my spinal cord is unpunctured. I even broke my neck in a fall.

                    A guy in rehab, I've diagnosed him as BS syndrome since. Had virtually same injury and return as me. Was hit in the head by dirt bike coming over hill.


                    It doesn't matter much in the long run. In the short run that info could have been useful.
                    Does This Wheelchair Make My Ass Look Fat?


                    • #11
                      My family has run into similar situations regarding the "quest" for diagnosis. My sister had a post surgical ischemic injury in the thoracic region, with the majority of the necrotic damage/scarring located in her right anterolateral thoracic cord. After about ten weeks (when a good portion of the post traumatic swelling resolved), her modality recovery was very similar to that of BS, however, since the anterior spinal artery and its radicular arteries were likely predominantly impacted at injury, her posterior column was never really damaged, or minimally damaged. She would be a good example of an incomplete injury that does not necessarily fit all the characteristics of just one of the "common" syndromes. By definition it is not BSS, since the posterior column was spared, and it also isnt truly ACS, as there was also substantial pain/temp deficit. This is fairly common if I recall, its rare to see a "pure" BSS, ACS, PCS, CCS, but a lot of incompletes often demonstrate a few symptomatic indicators of multiple "common" syndromes.

                      I wish you and your husband the best