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Brown-Séquard syndrome

Medical Professionals

Professional Reference articles are designed for health professionals to use. They are written by UK doctors and based on research evidence, UK and European Guidelines. You may find one of our health articles more useful.

Brown-Séquard's syndrome results from a lesion in one (lateral) half of the spinal cord (for example, hemisection or lateral injury of the cord). It often occurs in the cervical cord region. It was first described in the 1840s by Dr Charles-Édouard Brown-Séquard (1817-94).1

The syndrome is rare and comprises ipsilateral hemiplegia with contralateral pain and temperature sensation deficits (because of the crossing of the fibres of the spinothalamic tract).

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Interruption of the lateral corticospinal tracts, the lateral spinothalamic tract, and occasionally the posterior columns.


The causes of this syndrome are:

  • Most commonly(penetrating or blunt).2

  • Neoplasia (spinal cord tumour - either metastatic or primary).

  • Multiple sclerosis.

  • Degenerative (such as herniation of discs and cervical spondylosis).3 4

  • Cysts and cystic diseases.5

  • Idiopathic spinal cord herniation.6 (Spinal cord herniation can also occur after trauma.)7

  • Vascular causes:

    • Haemorrhage (including spinal subdural/epidural and haematomyelia).

    • Ischaemia.

  • Infectious causes: eg, meningitis, empyema, herpes zoster virus, herpes simplex virus, tuberculosis, syphilis.

  • Other causes: include gnathostomiasis (helminthic parasitic disease), and tropical spastic paraplegia (HTLV-1).

  • Rollercoaster riding and chiropractic manipulation may be a contributing factor if there is a predisposition (such as a cyst).8

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See also the separate article on Neurological History and Examination.

  • There is ipsilateral loss of position, light touch and vibration sensation at the level of the lesion.

  • There is contralateral loss of pain and temperature beginning a few segments below the lesion (because the spinothalamic tracts enter the cord and travel ipsilaterally for a few segments before decussating). No plantar response on this side because of loss of pain sensation.

  • There is ipsilateral spastic paraparesis with loss of vibration and joint-position sense (destruction of ipsilateral dorsal column fibres) below the lesion. Reflexes are brisk with upgoing plantar reflex.

  • There may be an ipsilateral Horner's syndrome if the sympathetic fibres are damaged (in the neck).9

  • There also sphincter disturbances.

Differential diagnosis

Diagnosis of Brown-Séquard's syndrome is made on the basis of the presenting history and examination. Most cases will be caused by trauma. It is important when there is no history of trauma to consider:

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Laboratory studies may be useful with non-traumatic causes. Overall they are not usually necessary for diagnosis. They may be useful in considering the differential diagnosis and for monitoring the clinical course.


  • Spinal plain radiographs (for bony injury in penetrating or blunt trauma).10

  • MRI scanning can help to define the extent of spinal cord injury. It is particularly helpful when evaluating non-traumatic causes. MRI may be needed in traumatic cases when there is neurological deterioration.11

  • CT myelography (useful if MRI is contra-indicated).


  • Initially, a thorough evaluation, including neurological examination, is performed to establish the level of injury.

  • Careful cervical spine/dorsal spine immobilisation is necessary.

  • No movement of the neck should be permitted.

  • It is important to identify cases (such as spinal cord herniation) where surgical intervention can improve prognosis.12 13


Early and late complications associated with spinal injury may occur. These may include:

  • Hypotension ('spinal shock').

  • Pulmonary embolism (prophylaxis needed).

  • Infection (lungs, urine, etc).

  • Depression (common with spinal cord injuries).


Historical footnote1

Charles-Édouard Brown-Séquard (1817-94) was a very remarkable and eminent neurologist who worked in England, France and the USA. He was one of the founding physicians at the Institute of Neurology in London. He published 577 papers. He initially intended to be a writer, but became a medical student when his manuscripts were rejected repeatedly.

He first published the findings which became 'Brown-Séquard's syndrome' in 1849 and he later described a typical case of his syndrome to the British Medical Association's annual meeting in 1862 - that of a sea captain stabbed in the neck. He also performed notable work in the emerging field of endocrinology.

Further reading and references

  • Shams S, Arain A; Brown Sequard Syndrome. StatPearls Sept 2022.
  • Hoebee S, Howard L, Komara J, et al; Newly Diagnosed Multiple Sclerosis Presenting as Brown-Sequard Syndrome: A Case Report. Clin Pract Cases Emerg Med. 2022 May;6(2):162-165. doi: 10.5811/cpcem.2022.2.55317.
  1. Laporte Y; Charles-Edouard Brown-Sequard: an eventful life and a significant contribution to the study of the nervous system. C R Biol. 2006 May-Jun;329(5-6):363-8. Epub 2006 May 3.
  2. Ceruti S, Previsdomini M; Traumatic Brown-Sequard syndrome. J Emerg Trauma Shock. 2012 Oct;5(4):371-2. doi: 10.4103/0974-2700.102421.
  3. Kim JT, Bong HJ, Chung DS, et al; Cervical disc herniation producing acute brown-sequard syndrome. J Korean Neurosurg Soc. 2009 May;45(5):312-4. doi: 10.3340/jkns.2009.45.5.312. Epub 2009 May 31.
  4. Abouhashem S, Ammar M, Barakat M, et al; Management of Brown-Sequard syndrome in cervical disc diseases. Turk Neurosurg. 2013;23(4):470-5. doi: 10.5137/1019-5149.JTN.7433-12.0.
  5. Cheng WY, Shen CC, Wen MC; Ganglion cyst of the cervical spine presenting with Brown-Sequard syndrome. J Clin Neurosci. 2006 Dec;13(10):1041-5.
  6. Parmar H, Park P, Brahma B, et al; Imaging of idiopathic spinal cord herniation. Radiographics. 2008 Mar-Apr;28(2):511-8.
  7. Francis D, Batchelor P, Gates P; Posttraumatic spinal cord herniation. J Clin Neurosci. 2006 Jun;13(5):582-6.
  8. Domenicucci M, Ramieri A, Salvati M, et al; Cervicothoracic epidural hematoma after chiropractic spinal manipulation therapy. Case report and review of the literature. J Neurosurg Spine. 2007 Nov;7(5):571-4.
  9. Meng Y, Zhou L, Liu X, et al; Brown-Sequard syndrome associated with Horner syndrome following cervical disc herniation. Spinal Cord Ser Cases. 2016 Dec 15;2:16037. doi: 10.1038/scsandc.2016.37. eCollection 2016.
  10. Miranda P, Gomez P, Alday R, et al; Brown-Sequard syndrome after blunt cervical spine trauma: clinical and radiological correlations. Eur Spine J. 2007 Aug;16(8):1165-70. Epub 2007 Mar 30.
  11. Jacobsohn M, Semple P, Dunn R, et al; Stab injuries to the spinal cord: a retrospective study on clinical findings and magnetic resonance imaging changes. Neurosurgery. 2007 Dec;61(6):1262-6; discussion 1266-7.
  12. Lee JK, Kim YS, Kim SH; Brown-Sequard syndrome produced by cervical disc herniation with complete neurologic recovery: report of three cases and review of the literature. Spinal Cord. 2007 Nov;45(11):744-8. Epub 2007 Feb 6.
  13. Uhl E, Holtmannspotter M, Tonn JC; Improvement of Brown-Sequard syndrome after surgical repair of an idiopathic thoracic spinal cord herniation. J Neurol. 2008 Jan;255(1):125-6. Epub 2008 Jan 22.
  14. Moskowitz E, Schroeppel T; Brown-Sequard syndrome. Trauma Surg Acute Care Open. 2018 Feb 20;3(1):e000169. doi: 10.1136/tsaco-2018-000169. eCollection 2018.

Article history

The information on this page is written and peer reviewed by qualified clinicians.

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