Objective
To describe a patient with incomplete Brown-Sequard syndrome (IBSS) due to sulcal artery syndrome (SAS).
Case
48-year-old man, presented with acute low back pain, right lower limb (LL) weakness, was associated with numbness over his left lower limb and difficult urination. There were no history of trauma or other constitutional symptoms.
Examination revealed right LL weakness with hyperreflexia, upgoing plantar response; Left LL show decreased temperature sense, light touch with T10 sensory level. Bilateral vibration and proprioception were normal.
Contrasted magnetic resonance imaging (MRI) of the thoracic spine showed T2- hyperintensed foci in the T7-T8 hemi-cord with corresponding diffusion-weighted sequence (DWI) hyperintensity (Fig.1). Lumbar puncture were normal. Anti-aquaporin 4 antibody was negative.
Result
Final diagnosis: IBBS from SAS.
Other aetiologies: aorta dissection, aneurysm, atherosclerotic plaques, cardioembolic, prothrombotic cause were excluded. Patient recovered fully in 1 week.
Conclusion
SAS should be consider in acute IBBS case. Pain is often the prominent feature at onset (94.4%) in our review.3 SAS has preferential involvement of cervical cord (90% of cases).3 Vertebral dissections, atherosclerosis disease and embolic source made up of majority of cases. 1,2,3,4 SAS often has good prognosis, majority of patient show significant recovery.3 Early MRI DWI is helpful in SCI, 3 some reports have shown that the changes occur as early as 3 hours.4 Conventional MRI during 3-46 hours after symptom onset, may failed to detect abnormalities.5 High degree of suspicious is needed for a SAS in patients presented with acute painful IBBS without trauma.