(Kiosk 1) Brown-séquard Syndrome (BSS) from Metastatic Mesothelioma

Case Diagnosis: Brown-Séquard syndrome from metastatic mesothelioma.

Case Description or Program Description: Patient with prior diagnosis of sarcomatoid type stage IIIB (cT4, cN1, cM0) malignant pleural mesothelioma, presented to acute care hospital with right upper extremity weakness. MRI of cervical spine demonstrated focal irregular intramedullary enhancement in the right hemicord at C7-T1 level with leptomeningeal enhancement along the right cord margin involving the C8 and T1 nerve roots, findings suspicious of leptomeningeal metastatic disease. She underwent chemotherapy and radiation. She presented 4 months later with respiratory distress due to pulmonary embolism and was found to be progressively weaker. Admitted to acute inpatient rehabilitation. Exam performed on admission demonstrated weakness to right finger flexors and abductors, and global weakness of right lower limb. Left upper and lower extremities maintained full motor strength. On sensory exam, light touch and pin prick were impaired at and below right C6 dermatome. Light touch was also abnormal at and below left C6 dermatome. Babinski sign was positive in right lower limb. Additional testing revealed absent temperature and vibration sensation in the left lower limb, and diminished proprioception in right lower limb. Findings were suggestive of Brown-Séquard syndrome (BSS).

Setting: Tertiary care hospital and Acute inpatient rehabilitation.

Assessment/Results: Patient underwent rehabilitation program and progressed from moderate assist at admission to contact guard assist for ambulation and independence at wheelchair level at the time of discharge.

Discussion (relevance): BSS is a rare condition and is often seen from penetrating trauma. This is a case of a patient with classic signs and symptoms of BSS resulting from nontraumatic metastatic disease who successfully completed acute inpatient rehabilitation.

Conclusions: Although BSS usually results from penetrating trauma, it can also occur in rare instances from metastatic mesothelioma.