Postoperative Brown-Séquard Syndrome: A Case Report
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An 82-year-old man presented with a progressive paraparesis that started a month before admission. His past medical history was unremarkable. Neurological examination revealed symmetric paraparesis (muscle power grade 4/5) below the T5 spinal cord segment. Babinski reflex and ankle clonus were present and both touches, pain, thermal and tactile sensations were preserved.

Spinal magnetic resonance imaging showed a hyperintense contrast-enhancing abnormal mass at the level of T6 which occupied the left side of the spinal canal and compressed the spinal cord. Further investigation revealed multiple metastatic lesions and prostate cancer as the probable primary neoplastic site. The patient underwent a T5-T7 laminectomy and complete removal of epidural tumoral mass.

On Day 2 post-op, the patient developed a right-sided BSS (right leg monoplegia and ipsilateral tactile, epicritic, and proprioceptive hyposthesia below T5 and thermal and pain left-sided anesthesia). Postoperative MRI revealed a de novo T2 hyperintensity, possibly due to retraction of the thecal sac during surgery and consequently spinal cord lesion. The patient remained in the ICU for 3 days in order to maintain vasopressor-induced high blood pressure and adequate spinal cord perfusion.The patient was referred to PT and started his motor rehabilitation program on Day 3 post-op.

Prior to discharge, the patient’s strength was grade 1/5 on the right leg and 4/5 on the left leg; he had proprioceptive impairment on both feet and hyposthesia below T5. Three months after discharge, the patient had partially recovered from the motor deficit on his lower right limb, having a motor strength grade 2/5. Neurological exam was otherwise unremarkable, having made a full recovery from the sensory deficit and motor deficit on his lower left limb (present preoperatively). MRI done at this time showed a reduction in the T2 hyperintensity seen in both previous post-op MR scans.