Case Report
Spinal Cord (2007) 45, 579–582; doi:10.1038/sj.sc.3101986; published online 14 November 2006
Brown-Séquard syndrome caused by a high velocity gunshot injury: a case report
M Reinke1, Y Robinson1, W Ertel1, R Kayser1 and C E Heyde1
1Department of Trauma and Orthopaedic Surgery, University Medical School, Charité – Campus Benjamin Franklin, Berlin, Germany
Correspondence: CE Heyde, Charité – Campus Benjamin Franklin, Klinik für Unfall- und Wiederherstellungschirurgie im, Zentrum für spezielle Chirurgie des Bewegungsapparates, Hindenburgdamm 30, 12200 Berlin, Germany
Abstract
Study design:
Case report.
Objective:
To present an unusual traumatic neurologic pathology caused by gunshot injury.
Setting:
Spine unit of Department of Trauma and Orthopaedic Surgery, University Medical School, Charité – Campus Benjamin Franklin, Berlin, Germany.
Method and result:
A 35-year-old male sustained a gunshot injury from a machine gun. The projectile caused a fracture of the left pedicle of Th10. The spinal cord was indirectly damaged by cavitation that caused a Brown-Séquard syndrome (BSS). After a microscopically assisted posterior revision at T9/10 with removal of bullet and bone fragments from the spinal canal and debridement of the bullet cavity via extended fenestrectomy the patient gained his motor function back. The sensory deficit remained unchanged.
Conclusion:
BSS can be caused by bullet-related injury of the spinal canal with no direct damage of neural structures. The initial treatment is always based on the total injury pattern. Possible spinal cord injuries are only clarified after restitution of vital functions. Decompression of neural structures in shotgun injury is indicated in incomplete paraplegia, injury of intra-abdominal hollow organs or high velocity bullet wounds. Through debridement and decompression of neural structures and chronic damage caused by foreign body granulomas can be prevented. Secondary destabilization of the spine should be avoided.
Keywords:
Brown-Séquard syndrome, incomplete paraplegia, gunshot injury, indirect spinal cord lesion
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