Spine: Brown-Sequard syndrome: practice question

A Orthopaedics 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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Orthopaedics · Spine: Brown-Sequard syndrome

Sample item

After a stab wound to the thoracic spine, a patient has right leg weakness with loss of vibration and proprioception on the right, and loss of pain and temperature on the left. What explains the left-sided sensory loss?

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

The answer and the reasoning

B. Spinothalamic fibres cross within a few segments of entry, so a right hemisection affects left pain and temperature

Hemisection of the cord produces ipsilateral loss of motor function (corticospinal tract) and of proprioception and vibration (dorsal columns), and contralateral loss of pain and temperature, as spinothalamic fibres cross to the opposite side near their entry. Penetrating injuries are the usual cause.

Option by option

  • A. Dorsal columns cross at the level of entry

    Dorsal columns cross in the medulla, not at the level of entry.

  • B. Spinothalamic fibres cross within a few segments of entry, so a right hemisection affects left pain and temperature (correct)

    Correct. Spinothalamic fibres cross soon after entry, so the deficit is contralateral.

  • C. Corticospinal tracts cross below the lesion

    Corticospinal tracts cross at the medullary decussation, above the lesion.

  • D. Pain fibres do not cross at all

    Pain fibres do cross.

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 Orthopaedics question

What is the answer to this Orthopaedics question?

The best answer is B, Spinothalamic fibres cross within a few segments of entry, so a right hemisection affects left pain and temperature. Hemisection of the cord produces ipsilateral loss of motor function (corticospinal tract) and of proprioception and vibration (dorsal columns), and contralateral loss of pain and temperature, as spinothalamic fibres cross to the opposite side near their entry.

Why is "Dorsal columns cross at the level of entry" not the answer?

Dorsal columns cross in the medulla, not at the level of entry.

Why is "Corticospinal tracts cross below the lesion" not the answer?

Corticospinal tracts cross at the medullary decussation, above the lesion.

Why is "Pain fibres do not cross at all" not the answer?

Pain fibres do cross.

What concept does this question test?

It tests Spine: Brown-Sequard syndrome in Orthopaedics. Penetrating injuries are the usual cause.

How hard is this question?

We tag it as an application question: it asks you to use a fact on a patient or a finding. 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 Spine: Brown-Sequard syndrome?

Pair each fracture with its classic complication and nerve injured. Then use the flashcards and the other Orthopaedics 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.