Neurology: Brown-Sequard syndrome: practice question

A General Medicine question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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General Medicine · Neurology: Brown-Sequard syndrome

Sample item

After a stab injury to the back, a man has weakness with loss of vibration and joint position sense in the right leg, and loss of pain and temperature in the left leg up to the umbilicus. Where is the lesion?

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

The answer and the reasoning

A. Right hemicord at about the T8 to T9 level

In hemisection, ipsilateral corticospinal and dorsal column fibres are interrupted, giving same-side weakness and loss of vibration and proprioception below the lesion. Spinothalamic fibres cross within one or two segments of entry, so pain and temperature loss is on the opposite side, with a level one to two segments below the lesion. The umbilicus is T10, so the lesion lies about T8 to T9.

Option by option

  • A. Right hemicord at about the T8 to T9 level (correct)

    Right-sided motor and dorsal column loss with left spinothalamic loss localises to the right hemicord, one or two segments above the T10 sensory level.

  • B. Anterior spinal artery territory at about the T10 level

    Anterior spinal artery infarction gives bilateral weakness and pain loss with preserved vibration and position sense.

  • C. Central cord at about the T10 level

    A central cord lesion mainly affects the upper limbs, with bilateral suspended pain and temperature loss.

  • D. Left hemicord at about the T8 to T9 level

    A left-sided lesion would produce left-sided weakness and proprioceptive loss with right-sided pain and temperature loss.

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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Questions about this General Medicine question

What is the answer to this General Medicine question?

The best answer is A, Right hemicord at about the T8 to T9 level. In hemisection, ipsilateral corticospinal and dorsal column fibres are interrupted, giving same-side weakness and loss of vibration and proprioception below the lesion.

Why is "Anterior spinal artery territory at about the T10 level" not the answer?

Anterior spinal artery infarction gives bilateral weakness and pain loss with preserved vibration and position sense.

Why is "Central cord at about the T10 level" not the answer?

A central cord lesion mainly affects the upper limbs, with bilateral suspended pain and temperature loss.

Why is "Left hemicord at about the T8 to T9 level" not the answer?

A left-sided lesion would produce left-sided weakness and proprioceptive loss with right-sided pain and temperature loss.

What concept does this question test?

It tests Neurology: Brown-Sequard syndrome in General Medicine. Spinothalamic fibres cross within one or two segments of entry, so pain and temperature loss is on the opposite side, with a level one to two segments below the lesion. The umbilicus is T10, so the lesion lies about T8 to T9.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Neurology: Brown-Sequard syndrome?

For each disease know the classic presentation, the best test, and the first-line treatment. Then use the flashcards and the other General Medicine questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.