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El síndrome de Brown-Séquard es el conjunto de signos y síntomas causado por hemisección medular de diversos orígenes. Puede generarse por múltiples causas; las traumáticas son las más frecuentes. Las causas menos frecuentes son patología inflamatoria, isquémica, tumoral o infecciosa. Se presenta un niño de 12 años, con instauración aguda y progresiva de un síndrome de hemisección medular derecho, con parálisis hipo/arrefléctica homolateral y afectación de sensibilidad termoalgésica contralateral. En la resonancia magnética de médula espinal, se observó compromiso inflamatorio en hemimédula derecha a nivel de segunda y tercera vértebras torácicas. Con diagnóstico de mielitis transversa idiopática, inició tratamiento con corticoide intravenoso a altas dosis con evolución clínica favorable y restitución de las funciones neurológicas.

Brown-Séquard syndrome refers to a set of signs and symptoms caused by hemisection of the spinal cord from various sources. It may have multiple causes; traumatic injuries are the most frequent ones. The less common causes include inflammation, ischemia, tumors, or infections. This report is about a 12-year-old boy with an acute and progressive course of right hemisection of the spinal cord, with ipsilateral hypo/areflexic paralysis and contralateral loss of thermalgesic sensation. The MRI of the spinal cord showed inflammation in the right side of the spinal cord at the level of the second and third thoracic vertebrae. The patient was diagnosed with idiopathic transverse myelitis and was started on intravenous high-dose corticosteroids; he showed a favorable clinical course and recovered neurological functions.

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RESUMEN Introducción: El síndrome de Brown-Séquard representa entre el 1 y el 4 % de todas las lesiones medulares espinales; es muy infrecuente. Compromete la mitad lateral de la médula espinal y se afectan unilateralmente las estructuras o funciones del segmento dorsal, el tracto corticoespinal y el tracto espinotalámico. Objetivo: Mostrar una forma de presentación atípica de la hernia discal cervical en una paciente joven sin antecedentes de traumatismo ni esfuerzo físico. Caso clínico: Paciente femenina de 24 años de edad, que presenta disminución de la fuerza muscular en los miembros del lado izquierdo, de forma progresiva, con dificultades para deambular, así como dolor cervical de intensidad moderada. Se le diagnostica una hernia discal cervical y se realiza tratamiento quirúrgico con evolución satisfactoria. Conclusiones: En el síndrome de Brown-Séquard causado por discopatía cervical, el tratamiento oportuno determina de forma esencial el mejoramiento de los síntomas de forma rápida; la fisioterapia y rehabilitación juegan un papel fundamental en la recuperación motora.

ABSTRACT Introduction: Brown-Séquard syndrome accounts for 1 to 4 % of all spinal cord injuries, very infrequent. It involves the lateral half of the spinal cord and the structures and/or functions of the dorsal segment, the corticospinal tract and the spinothalamic tract are unilaterally affected. Objective: To show an atypical presentation of cervical disc herniation in a young female patient with no history of trauma or physical exertion. Clinical case: A 24-year-old female patient presented with a progressive decrease in muscle strength on the left side of the limbs, with difficulty in walking, as well as moderate cervical pain. She was diagnosed with a cervical disc herniation and surgical treatment was performed with satisfactory evolution. Conclusions: In Brown-Séquard Syndrome caused by cervical disc disease, timely treatment is essential for rapid improvement of symptoms; physiotherapy and rehabilitation play a key role in motor recovery.

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Resumen: El término SCIWORA (Spinal Cord Injury Without Radiologic Abnormality) describe una patología poco frecuente que afecta principalmente a pacientes pediátricos. Presentamos el caso de un paciente adolescente diagnosticado con SCIWORA/síndrome de Brown Séquard, el cual presenta múltiples contusiones en cuello y hemicuerpo derecho, de manera inmediata refiere parestesias en las cuatro extremidades y hemiparesia espástica con predominio derecho, incapacidad a la bipedestación y continencia urinaria. Se inicia tratamiento basado en el estudio NASCIS III y posterior a la pruebas de imagen se realizó diagnóstico ya comentado. Exponemos las definiciones más actuales de SCIWORA y las recomendaciones para realizar su diagnóstico así como su relación y coexistencia con síndromes medulares.

Abstract: SCIWORA (Spinal Cord Injury without Radiologic Abnormality) is a rare condition that mainly affects pediatric patients; We present the case of a teenage male patient diagnosed with SCIWORA/Brown Séquard Syndrome. In admission, he has multiple bruises on his neck and right hemibody and immediately he refers paraesthesia in all four limbs and spastic hemiparesis with right predominance, as well as inability to stand up and urinary continence. Treatment based on NASCIS III study is initiated and after the imaging tests, a diagnosis has already been made. We present the most current definitions of SCIWORA and the recommendations to make its diagnosis, as well as its relationship and coexistence with spinal syndromes.

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Charles-Edouard Brown-Séquard (1817-1894) fue un importante científico reconocido por sus investigaciones sobre la médula espinal. Nació en la isla de Mauricio, adquirió un gusto por la literatura, incluso para partir a París con veinte años junto con su madre para convertirse en escritor. Al fracasar en este sueño, inició su carrera de medicina, destacándose por sus descubrimientos en la fisiología de la médula espinal, ampliamente descritos en su tesis de grado, en 1846, y posteriormente, en 1855, cuando acuñó el síndrome con su nombre. Sus estudios incluyeron las áreas de epilepsia, control simpático en el mecanismo vasomotor, redes interneuronales y endocrinología. Este artículo resalta los aportes de este genio y explica la historia del síndrome con su nombre. Además, expone, entre otros temas de interés, el análisis del artículo original publicado en 1855. Desde una revisión histórica sobre patología de la médula espinal, luego de su trabajo e investigaciones de esta área. Terminando con su trabajo, donde por medio de casos y experimentos, demostró los hallazgos que se conocerían como síndrome de Brown-Séquard, que ha inspirado numerosos estudios posteriores.

Charles-Edouard Brown-Séquard (1817-1894), was a remarked scientific by his investigations mainly of the spinal cord, born on Mauritius Island acquired a taste for literature, even to go to Paris at 15 years old with his mother to become a writer. Failing in this dream, began his career in medicine, standing out for discoveries in the physiology of the spinal cord, described in his thesis of degree in 1846 and later in 1855 when he coined the syndrome with his name. His studies included subjects in epilepsy, sympathetic control of vasomotor mechanism, interneuronal networks and advances in endocrinology. This article highlights the contributions of this genius and explains the history of the syndrome with his name. In addition, among other topics of interest, it exposes the analysis of the original article published in 1855. From a historical review on spinal cord pathology, followed by his work and investigations of this area. Finishing with his work, where it demonstrates the findings that would be known as Brown-Séquard syndrome through cases and experiments.

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O trauma raquimedular (TRM) é uma importante causa de incapacidade, sendo constatado uma incidência média de 21 pacientes por milhão de habitantes por ano por uma revisão sistemática realizada nas cinco regiões do pais em. Em Belo Horizonte essa incidência chegou a 26 pacientes por milhão por ano. Trata-se de AFC, 28 anos, que foi encaminhado com urgência para o Hospital João XXIII com história de agressão por arma branca (um facão) na região supra clavicular esquerda no dia 22/10. Ao exame neurológico o paciente encontrava-se consciente, orientado e com hemiplegia á esquerda. Anestesia tátil e vibratória á esquerda (lesão do trato corticoespinhal e fascículo grácil e cuneiforme) e preservada á direita, além de anestesia térmica/dolorosa contralateral a hemissecção (lesão do trato espinotalâmico), que configuram a síndrome de Brown Sequard completa. Foi realizada tomografia computadorizada da coluna que evidenciou fratura de lâmina de T1. A ferida lacerante foi suturada e paciente manteve quadro estável por 5 dias. Após 7 dias da admissão hospitalar constatou-se anisocoria com pupila miótica à esquerda e ptose de pálpebra também a esquerda, que configura a síndrome de Horner concomitantemente. Foi realizada punção lombar constatando liquor hemorrágico e com alta celularidade, iniciado antibioticoterapia com Meropenem e Vancomicina. Relata-se a correlação anátomoclínica de paciente vitima de TRM aberto, com síndromes associadas, de hemissecção medular e Horner. Ressalta-se a importância dos conhecimentos em neuroanatomia. (AU)

Spinal cord trauma is an important cause of disability, with an average incidence of 21 patients per million inhabitants per year by a systematic review in the five regions of Brazil. In Belo Horizonte, this incidence reached 26 patients per million per year. This is the AFC, 28 years old, who was referred urgently to the Hospital João XXIII with a history of white-collar aggression (a machete) in the left supraclavicular region on 22/10. At the neurological examination the patient was conscious, oriented and with left hemiplegia. Tactile and vibratory anesthesia to the left (lesion of the corticospinal tract and gracile and cuneiform fasciculus) and preserved to the right, in addition to thermal / painful anesthesia contralateral to the hemisection (lesion of the spinothalamic tract), which constitute the complete Brown Sequard syndrome. Computed tomography of the spine was performed, showing a T1 fracture. The lacerating wound was sutured and patient maintained stable frame for 5 days. After 7 days of hospital admission, anisocoria was observed with miotic pupil on the left and ptosis of the eyelid also on the left, which configures Horner syndrome concomitantly. A lumbar puncture was performed, confirming hemorrhagic and high cellularity, and antibiotic therapy with Meropenem and Vancomycin. The anatomic-clinical correlation of a patient with open MTR with associated syndromes of medullary and Horner hemisection is reported. The importance of knowledge in neuroanatomy is emphasized. (AU)

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O trauma raquimedular (TRM) é uma importante causa de incapacidade, sendo constatado uma incidência média de 21 pacientes por milhão de habitantes por ano por uma revisão sistemática realizada nas cinco regiões do pais em. Em Belo Horizonte essa incidência chegou a 26 pacientes por milhão por ano. Trata-se de AFC, 28 anos, que foi encaminhado com urgência para o Hospital João XXIII com história de agressão por arma branca (um facão) na região supra clavicular esquerda no dia 22/10. Ao exame neurológico o paciente encontrava-se consciente, orientado e com hemiplegia á esquerda. Anestesia tátil e vibratória á esquerda (lesão do trato corticoespinhal e fascículo grácil e cuneiforme) e preservada á direita, além de anestesia térmica/dolorosa contralateral a hemissecção (lesão do trato espinotalâmico), que configuram a síndrome de Brown Sequard completa. Foi realizada tomografia computadorizada da coluna que evidenciou fratura de lâmina de T1. A ferida lacerante foi suturada e paciente manteve quadro estável por 5 dias. Após 7 dias da admissão hospitalar constatou-se anisocoria com pupila miótica à esquerda eptose de pálpebra também a esquerda, que configura a síndrome de Horner concomitantemente. Foi realizada punção lombar constatando liquor hemorrágico e com alta celularidade, iniciado antibioticoterapia com Meropenem e Vancomicina. Relata-se a correlação anátomoclínica de paciente vitima de TRM aberto, com síndromes associadas, de hemissecção medular e Horner. Ressalta-se a importância dos conhecimentos em neuroanatomia. (AU)

Spinal cord trauma is an important cause of disability, with an average incidence of 21 patients per million inhabitants per year by a systematic review in the five regions of Brazil. In Belo Horizonte, this incidence reached 26 patients per million per year. This is the AFC, 28 years old, who was referred urgently to the Hospital João XXIII with a history of white-collar aggression (a machete) in the left supraclavicular region on 22/10. At the neurological examination the patient was conscious, oriented and with left hemiplegia. Tactile and vibratory anesthesia to the left (lesion of the corticospinal tract and gracile and cuneiform fasciculus) and preserved to the right, in addition to thermal / painful anesthesia contralateral to the hemisection (lesion of the spinothalamic tract), which constitute the complete Brown Sequard syndrome. Computed tomography of the spine was performed, showing a T1 fracture. The lacerating wound was sutured and patient maintained stable frame for 5 days. After 7 days of hospital admission, anisocoria was observed with miotic pupil on the left and ptosis of the eyelid also on the left, which configures Horner syndrome concomitantly. A lumbar puncture was performed, confirming hemorrhagic and high cellularity, and antibiotic therapy with Meropenem and Vancomycin. The anatomic-clinical correlation of a patient with open MTR with associated syndromes of medullary and Horner hemisection is reported. The importance of knowledge in neuroanatomy is emphasized. (AU)

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As lesões traumáticas da medula espinhal provocadas por objetos perfurantes retidos são raras e configuram um desafio para o cirurgião da coluna vertebral. A cirurgia precoce pode minimizar o risco de sequela neurológica. Exames de diagnósticos por imagem são fundamentais para o planejamento e sucesso terapêutico, mas não devem retardar o tratamento cirúrgico. Os autores descrevem um caso de lesão medular por arma branca retida provocando a síndrome de Brown-Séquard e discutema abordagem terapêutica. Os objetivos da cirurgia são a retirada do objeto retido, sem causar déficit motor ou sensitivo adicional, e a correção da lesão dural e de eventuais instabilidades da coluna.

Traumatic spinal cord injuries caused by perforating retained objects are rare and challenging for spinal surgeons. Early surgery can minimize the risk of neurological sequelae. Diagnostic imaging exams are essential for planning and therapeutic success, but should not delay surgical treatment. The authors describe a case of spinal cord injury by stab retained causing Brown-Sequard syndrome and discuss the therapeutic approach. The goal of surgery is the removal of the object retained without causing additional motor or sensory deficit, fix the dural injury and possible spinal instabilities.

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A Síndrome de Brown-Séquard (SBS) é caracterizada pela perda da função motora, propriocepção e sensibilidade vibratória ipsilateral e perda da sensibilidade tátil e dolorosa contralateral à hemissecção medular. É principalmente causada por fraturas da coluna vertebral ou tumores extramedulares. Hérnia discal cervical não traumática é uma etiologia rara, havendo 31 relatos em literatura indexada até o momento. Paciente do sexo masculino, 23 anos, admitido com parestesia em dimídio esquerdo e fraqueza no hemicorpo direito há cerca de 35 dias da internação. Sem relatos de trauma. Ao exame: consciente e orientado, hemiparesia à direita e hemi-hipoestesia tátil dolorosa à esquerda com nível motor e sensitivo em C7. Os exames de imagem evidenciaram um canal estreito cervical de C4-T1, presença de hérnia discal extrusa C5-C6 e hipersinal medular a esse nível. Foi submetido à discectomia e artrodese cervical anterior de C5-C6. No pós-operatório, evoluiu com tetraplegia flácida (nível motor/sensitivo em C8). Os exames de controle mostraram correto posicionamento do instrumental cirúrgico, ausência de hérnias discais e manutenção do hipersinal medular. Após oito meses de reabilitação e seguimento ambulatorial, permanece tetraparético. Descrevemos o primeiro caso brasileiro, em literatura indexada, de SBS causada por hérnia discal cervical não traumática. Há um predomínio pelo sexo masculino, a média de idade é de 45 anos e o disco intervertebral C5-C6 é o mais acometido. Microdiscectomia e fusão intersomática são as formas mais comuns de tratamento. Após a descompressão precoce, há um bom prognóstico, com recuperação da motricidade na maioria dos casos.

The Brown-Séquard's Syndrome is characterized by loss of motor function, proprioception and vibration sensitivity ipsilateral and loss of tactile and painful contralateral to hemisection spinal cord. It is mainly caused by fractures of the spine or extramedullary tumors. Nontraumatic cervical herniated disc etiology is rare, with only 31 cases indexed in the literature. Male patient, 23 years old, admitted with numbness in left side and weakness in the right hemisphere, hospitalized for about 35 days. No reports of trauma. On examination: conscious and oriented, right hemiparesis and hemihipoestesia tactile-painful in left side, with sensory and motor level C7. Imaging tests showed a narrow channel of cervical C4-T1, presence of disc herniation extrusa C5-C6 and hyperintense marrow at this level. Underwent cervical discectomy and arthrodesis of C5-C6. Postoperatively evolved with flaccid tetraplegia (level motor/sensory C8). The control examinations showed correct position surgical instruments, lack of disc herniations and maintenance of spinal cord hyperintense. After eight months of rehabilitation and outpatient services remains tetraparesis. To the authors' best knowledge, this is the first description of BSS caused by nontraumatic cervical disc herniation in Brazil, in the indexed literature. In the affected patients, there is a predominance of males, with mean age 45 years, and the C5-C6 intervertebral disc is the most affected. Microdiscectomy and interbody fusion are the most common forms of treatment. After early decompression, there is a good prognosis, with recovery of motor function in most cases.

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OBJETIVO: describir la resolución quirúrgica de un caso de hernia medular transdural. Descripción: Paciente de 33 años de edad con antecedentes de historia progresiva de debilidad motora de 6 meses de evolución. Al examen se constató paraparesia asimétrica con anestesia por debajo del dermatoma T8, constituyendo un síndrome de Brown Sequard. En las imágenes de resonancia magnética se observó herniación ventral de la medula espinal a nivel T7-8. INTERVENCIÓN: se realizó abordaje extrapleural posterolateral a la columna torácica. Con técnica microquirúrgica se encontró el defecto dural en la duramadre ventral, y la herniación medular correspondiente en el nivel T7-8. Se encontraron, asimismo, cuerpos osteocartilaginosos en dicho nivel. Se procedió a disecar la interface médula espinal del defecto dural, ampliando el mismo y liberando la médula espinal, sin necesidad de retracción medular por esta vía. Luego de reponer en su correcta posición a la médula se procedió al cierre dural primario con microsutura. CONCLUSIÓN: las hernias medulares transdurales torácicas el abordaje posterolateral extracavitario es una opción válida, permitiendo tener una mejor visión microquirúrgica de la duramadre ventral, con la ventaja de no requerir tracción ni rotación neural como se requiere en el caso de la laminectomía tradicional

OBJECTIVE: to describe the successful surgical repair of idiopathic transdural spinal cord herniation DESCRIPTION: the patient was a 33-year-old female with a 6-month history of progressive motor weakness. Neurologic examination revealed asymmetric paraparesis with anesthesia below the T8 dermatome, consistent with Brown-Séquard Syndrome. Magnetic resonance imaging (MRI) of the thoracic spine demonstrated a spinal cord that was displaced and herniated ventrally, with loss of the normal overlying cerebrospinal fluid space between T7 and T8. INTERVENTION: a lateral extra-pleural approach was used to access the thoracic spine. With microsurgery, we identified a defect in the ventral dura, with transdural spinal cord herniation. Osteocartilaginous bodies also were observed. Microsurgical un-tethering of the spinal cord herniation was performed along with primary repair of ventral dural defect. To un-tether the herniation without spinal cord manipulation, an incision was made on one side of the defect; with this maneuver, the diameter of the defect was increased, avoiding any traction on neural structures. Once the herniated spinal cord was freed, the ventral dura was repaired via non-interrupted closure. CONCLUSION: the posterolateral extra-pleural approach is a good option to treat spinal cord herniation in the thoracic spine, providing a better optical corridor to detect ventral dural defects than with a thoracic laminectomy, and avoiding any neural traction or rotation

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Brown-Séquard, a remarkable medical personality of the 19 th century, was born in a small island of the Indian Ocean. He travelled over the world exerting his skills: a successful physician, and an innovative researcher, with a very ample range of interests. His favored subject was the nervous system. The spinal cord was studied extensively, with novel and important discoveries on the sensory pathways. He identified cases with spinal cord hemisection, and described the clinical presentation corresponding to a syndrome which bears his name (Brown-Séquard syndrome), for which he is best known among neurologists. Regarding the brain, he proposed nine mental and physical functions (organs) related to dynamically interconnected cell clusters, in harmony with the “ réseau de cellules anastomosées ”, “ activités dynamogeniques et inhibitrices ”, and “ action à distance ” concepts. Finally, he is considered by some as the “father” of endocrinology, due to his studies on glands and their secretions.

Brown-Séquard, notável personalidade médica do século 19, nasceu em uma pequena ilha do Oceano Índico. Viajou pelo mundo exercendo suas habilidades: médico de sucesso e pesquisador ousado, com gama muito extensa de interesses. Seu assunto favorito era o sistema nervoso. A medula foi estudada de modo amplo, com descobertas novas e importantes sobre as vias sensitivas. Identificou casos com hemisseção medular e descreveu o quadro clínico correspondente a uma síndrome que leva seu nome (síndrome de Brown-Séquard), motivo pelo qual é melhor conhecido entre os neurologistas. Considerando o cérebro, propôs nove funções (órgãos) mentais e físicas relacionadas de modo dinâmico a conglomerados celulares, em harmonia com seus conceitos de “ réseau de cellules anastomosées ”, “ activités dynamogeniques et inhibitrices ” e “ action à distance ”. Finalmente, ele é considerado por alguns como “pai” da endocrinologia, devido seus estudos sobre glândulas e suas secreções.

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