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LETTER TO EDITOR
Year : 2014  |  Volume : 62  |  Issue : 4  |  Page : 473

Hematomyelia as a cause of brown-sequard's syndrome in a hypofibrinogenemic patient


Department of Neurology, M S Ramaiah Medical College, Bengaluru, Karnataka, India

Date of Web Publication19-Sep-2014

Correspondence Address:
B K Madhusudhan
Department of Neurology, M S Ramaiah Medical College, Bengaluru, Karnataka
India
B K Madhusudhan
Department of Neurology, M S Ramaiah Medical College, Bengaluru, Karnataka
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0028-3886.141296

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How to cite this article:
Madhusudhan B K, Mahendra J V, Sandya, Rohan M, Srinivasa R, Madhusudhan B K, Mahendra J V, Sandya, Rohan M, Srinivasa R. Hematomyelia as a cause of brown-sequard's syndrome in a hypofibrinogenemic patient . Neurol India 2014;62:473

How to cite this URL:
Madhusudhan B K, Mahendra J V, Sandya, Rohan M, Srinivasa R, Madhusudhan B K, Mahendra J V, Sandya, Rohan M, Srinivasa R. Hematomyelia as a cause of brown-sequard's syndrome in a hypofibrinogenemic patient . Neurol India [serial online] 2014 [cited 2020 Oct 31];62:473. Available from: https://www.neurologyindia.com/text.asp?2014/62/4/473/141296


Sir,

Brown-Sequard syndrome (BSS) is most commonly described in conjunction with a spinal cord traumatic injury. Other causes include extramedullary spinal neoplasm, cervical disc herniation, spinal epidural hematoma, multiple sclerosis and myelitis. [1],[2],[3] Spontaneous spinal intramedullary hemorrhage or hematomyelia as a cause of BSS has not been reported. Herein, we report a case of hypofibrogenemia with hematomyelia presenting as BSS.

A 25-year-old female presented with sudden weakness of left upper limb and lower limb and sensory impairment to temperature on the contralateral side of two days duration and urinary retention of one-day duration. She was a known case of congenital hypofibrinogenemia, diagnosed in childhood. Neurologic examination revealed hypertonia in left upper and lower limbs with motor power of 1/5 and normal tone and motor power (5/5) on right side. Deep tendon reflexes were exaggerated with clonus and extensor plantar response on left side and normal deep tendon reflexes on right side. Sensory system examination revealed decreased sensation of vibration and position on left side and loss of pain and temperature on right side below C4 level. There were no other deficits. Lab data showed APTT of 120, INR of 10 and serum fibrinogen was decreased (56). Magnetic resonance imaging (MRI) of the brain revealed old bilateral parietooccipital lobe hemorrhagic infarcts. Punctate areas of hemorrhage were noted in the right cerebellum. MRI of whole spine revealed bleed at C3 C4 with surrounding perilesional edema. Cervical spine saggital sections on T1- and T2-weighted images revealed a long segment T1-hypo T-hyperintensity lesion extending from C2 to C4 segments suggestive of edema [Figure 1]. Axial sections on GE and T2 at C3 C4 level revealed a left intramedullary area of blooming and hypointensity with surrounding hyperintensity suggestive of perilesional edema. Patient was treated with steroids cryoprecipitate FFP transfusion and physiotherapy. There was good improvement in the motor power.
Figure 1: MRI cervical spine saggital sections on T1 and T2 weighted images a long segment T1hypo T2 hyperintensity extending from C2 to C4 segments suggestive of oedema. Axial sections on GE and T2 at C3 C4 level revealed a left intramedullary area of blooming and hypointensity with surrounding hyperintensity suggestive of perilesional oedema

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The BSS is an incomplete spinal cord lesion characterized by ipsilateral loss of motor function proprioception and vibratory sensation combined with contralateral loss of pain and temperature sensations. Classical or pure BSS is seen in spinal cord trauma and multiple sclerosis. Extramedullary causes present with incomplete forms (2) It is important in diagnosing this rare neurological emergency of this patient both in terms of etiology and presentation. This is probably the first case report of BSS presenting due to hematomyelia.

 
  References Top

1.Egido Herrero JA, Saldanã C, Jiménez A, Vázquez A, Varela de Seijas E, Mata P. Spontaneous cervical epidural hematoma with Brown-Séquard syndrome and spontaneous resolution. Case report. J Neurosurg Sci 1992;36:117-9.  Back to cited text no. 1
    
2.Koehler PJ, Endtz LJ. The Brown-Séquard syndrome. True or false? Arch Neurol 1986;43:921-4.  Back to cited text no. 2
    
3.Adamson DC, Bulsara K, Bronec PR. Spontaneous cervical epidural hematoma: Case report and literature review. Surg Neurol 2004;62:156-60.  Back to cited text no. 3
    


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