Controversies in the differential diagnosis of Brown-Sequard syndrome due to cervical spinal disease from stroke: A case series
Vaner Koksal1, Ozcan Yavasi2
1Department of Neurosurgery, Recep Tayyip Erdoğan University, Research and Training Hospital, Rize, Turkey
2Department of Emergency Medicine, Recep Tayyip Erdoğan University, Research and Training Hospital, Rize, Turkey
Keywords: Brown-Sequard syndrome; Cervical cord; Herniated disc; Spinal epidural hematoma; Stroke
Stroke is generally considered to be the first preliminary diagnosis in patients presenting with acute hemiparesia in the emergency department. But rarely in unexpected spontaneous neurological pathologies that may lead to hemiparesis. The data from 8 non-traumatic patients who underwent surgical treatment for brown-sequard syndrome (BSS) were reviewed retrospectively. All patients were initially misdiagnosed with strokes. Two of the patients had spinal canal stenosis, two had spinal epidural hematomas, one had an ossified herniated disc and three had soft herniated discs. None of the patients complained of significant pain at the initial presentation. All of the patients had a mild sensory deficit that was initially unrecognized. The pain of the patients began to become evident after hospitalization and, patients transferred to neurosurgery department. Cervical spinal pathologies compressing the corticospinal tract in one-half of the cervical spinal canal may present with only hemiparesis, without neck and radicular pain. If it's too late, permanent neurological damage may become inevitable while it is a correctable pathology.