A patient is admitted to the ICU with a C7 spinal cord injury and diagnosed with Brown-Séquard syndrome. On physical examination, the nurse would most likely find:

The highest priority in a patient with a recent T12 spinal cord injury is prevention of further spinal cord damage. At one week post-injury, the spinal cord remains vulnerable to secondary injury from movement, improper handling, or additional trauma. Protecting the spinal cord ensures that existing neurological function is preserved, which is critical for long-term outcomes.

Rationale for correct answer:
1. Prevention of further damage to the spinal cord. Maintaining spinal immobilization, careful positioning, and avoiding movements that could exacerbate injury are essential to prevent additional neurological loss. Preserving remaining function is the most critical immediate concern.

Rationale for incorrect answers:
2. Prevention of contractures of the lower extremities. This is important for long-term mobility and function but is a secondary priority compared to protecting the spinal cord.
3. Prevention of skin breakdown of areas that lack sensation. Pressure injury prevention is critical, but it is not more urgent than preventing permanent neurological damage.
4. Prevention of postural hypotension when placing the client in a wheelchair. Orthostatic hypotension precautions are necessary during rehabilitation but are not the immediate priority in the acute post-injury phase.

Take-home points:

• Immediate care after SCI focuses on protecting the spinal cord to preserve neurological function.
• Secondary concerns include contracture prevention, skin care, and hemodynamic stability.
• Early and careful handling can significantly influence long-term functional outcomes.

Brown-Séquard syndrome is a type of incomplete spinal cord lesion caused by hemisection of the spinal cord, often due to trauma such as a stab wound. The hallmark finding is ipsilateral motor paralysis and loss of proprioception below the level of the lesion, along with contralateral loss of pain and temperature sensation. This occurs because the corticospinal and dorsal column tracts cross at different levels of the central nervous system, leading to a distinct pattern of deficits.

Rationale for correct answer:
4. Ipsilateral motor loss and contralateral sensory loss below C7. Damage to the corticospinal tract on one side causes motor weakness on the same side, while disruption of the spinothalamic tract leads to loss of pain and temperature on the opposite side. This combination is the classic presentation of Brown-Séquard syndrome.

Rationale for incorrect answers:
1. Upper extremity weakness only. This finding would not fully explain the mixed motor and sensory deficits seen in Brown-Séquard syndrome, and it is more characteristic of central cord syndrome.

2. Complete motor and sensory loss below C7. This describes complete spinal cord injury, not an incomplete lesion like Brown-Séquard syndrome. Patients retain some functions because only one half of the cord is damaged.

3. Loss of position sense and vibration in both lower extremities. This pattern would be more consistent with posterior cord syndrome, where bilateral loss of proprioception occurs without significant motor involvement.

Take-home points:

• Brown-Séquard syndrome produces a classic asymmetric pattern: motor and proprioception loss on the same side, and pain/temperature loss on the opposite side.
• It results from hemisection of the spinal cord, often due to trauma such as a stab wound or tumor.
• Differentiating incomplete cord syndromes is critical for accurate assessment and targeted rehabilitation.