A 45-year-old patient sustained a stab wound to the right side of the spinal cord at T6. During the physical therapy evaluation, which of the following findings BEST confirm a diagnosis of Brown-Séquard syndrome?

A 45-year-old patient sustained a stab wound to the right side of the spinal cord at T6. During the physical therapy evaluation, which of the following findings BEST confirm a diagnosis of Brown-Séquard syndrome?

• A. Bilateral loss of motor function and pain/temperature below T6
• B. Bilateral upper extremity weakness greater than lower extremity weakness
• C. Right-sided loss of pain and temperature with left-sided motor paralysis below T6
• D. Right-sided motor paralysis and loss of proprioception below T6 with left-sided loss of pain and temperature below T6

Answer: (D)

Brown-Séquard syndrome comes from a hemisection of the spinal cord, producing an asymmetrical pattern: ipsilateral motor weakness and loss of dorsal column modalities (proprioception and vibration) below the level of the lesion, together with contralateral loss of pain and temperature starting a few levels below the lesion. In this scenario, a stab wound on the right side at T6 would cause right-sided motor paralysis and loss of proprioception below T6, while pain and temperature are lost on the left below T6. That combination—ipsilateral motor and proprioception loss with contralateral pain/temperature loss below the injury level—best confirms Brown-Séquard syndrome. Other patterns described in the distractors don’t fit the classic hemisection physiology: Brown-Séquard is not bilateral; the pain/temperature loss is not on the same side as the motor deficit, and the upper vs. lower extremity distribution isn’t the defining feature here.

Brown-Séquard syndrome comes from a hemisection of the spinal cord, producing an asymmetrical pattern: ipsilateral motor weakness and loss of dorsal column modalities (proprioception and vibration) below the level of the lesion, together with contralateral loss of pain and temperature starting a few levels below the lesion. In this scenario, a stab wound on the right side at T6 would cause right-sided motor paralysis and loss of proprioception below T6, while pain and temperature are lost on the left below T6. That combination—ipsilateral motor and proprioception loss with contralateral pain/temperature loss below the injury level—best confirms Brown-Séquard syndrome.

Other patterns described in the distractors don’t fit the classic hemisection physiology: Brown-Séquard is not bilateral; the pain/temperature loss is not on the same side as the motor deficit, and the upper vs. lower extremity distribution isn’t the defining feature here.