Neuroanatomy: Brown-Sequard syndrome: practice question

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Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

C. Left spastic weakness and loss of joint position sense, with right loss of pain and temperature

In hemisection, the corticospinal tract and the dorsal columns lie ipsilateral to the lesion because they cross higher (in the medulla), so motor loss and loss of position and vibration sense are ipsilateral. Spinothalamic fibres cross within one or two segments of entering the cord, so pain and temperature loss is contralateral and begins a level or two below the lesion.

Option by option

• A. Bilateral loss of pain and temperature with preserved position sense

  Bilateral loss of pain and temperature with intact position sense suggests a central cord process such as syringomyelia.

• B. Bilateral flaccid paralysis with sparing of sacral sensation

  Bilateral flaccid paralysis with sacral sparing suggests an incomplete central cord pattern and not a unilateral hemisection.

• C. Left spastic weakness and loss of joint position sense, with right loss of pain and temperature (correct)

  Ipsilateral motor and dorsal column deficit with contralateral spinothalamic deficit is the Brown-Sequard pattern.

• D. Right spastic weakness and loss of joint position sense, with left loss of pain and temperature

  The sides are reversed in this option, because the corticospinal tract and dorsal columns have not yet crossed.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

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