Brown-Séquard syndrome in a 11-year-old girl due to penetrating glass injury to the thoracic spine

• Published in: European journal of orthopaedic surgery & traumatology Vol. 23; no. Suppl 2; pp. 141 - 143
• Main Authors: Komarowska, M., Debek, W., Wojnar, J. A., Hermanowicz, A., Rogalski, M.
• Format: Journal Article
• Language: English
• Published: Paris Springer Paris 01.11.2013; Springer Nature B.V
• Subjects: Brown-Sequard Syndrome - etiology; Child; Female; Foreign bodies; Foreign Bodies - complications; Humans; Medicine; Medicine & Public Health; Paralysis; Pediatrics; Spinal cord; Spinal Cord Injuries - etiology; Surgical Orthopedics; Thoracic Vertebrae; Trauma; Traumatic Surgery; Up-to date Review and Case Report; Wounds, Stab - complications; Spinal cord injury; Brown-Séquard syndrome; Stab wound
• ISSN: 1633-8065; 1432-1068
• DOI: 10.1007/s00590-012-1050-8

Injuries in children are one of the most frequent causes of high morbidity and mortality, and they present a challenge to the treating physician. Fortunately, spinal trauma in pediatric patient is relatively rare. Brown-Séquard syndrome is a rare form of incomplete spinal cord injury consisting of ipsilateral upper motor neuron paralysis (hemiplegia) and loss of proprioception with contralateral pain and temperature sensation deficits resulting from hemisection or lateral injury to the spinal cord. A 11-year-old girl was admitted to our Pediatric Trauma Emergency Department after she had suffered a penetrating back injury. Neurological examination demonstrated left lower extremity paresis and moderate spastic paralysis of the right lower extremity. The examination showed loss of temperature sensation contralateral to and below the lesion. The examination of the pain sensation was difficult because the patient was in pain shock, but it was diminished on the side opposite to the damage. Multislice spiral computed tomography (MSCT) demonstrated a triangular foreign body in spinal canal at the level of the Th11–Th12. After a Th 11 –L 2 laminectomy and retrieval of foreign bodies, dura repair was performed. Patient was discharged from the hospital with partial recovery. Operative decompression of the neural elements in case of spinal canal compromise is the treatment of choice. Indication for surgical intervention in existing cerebrospinal fluid fistula includes closure of the dura and reducing neural elements compression and lowering the risk of infectious complications by removing bone or foreign body fragments. Patients with Brown-Séquard syndrome have good prognosis for functional recovery.