Courtesy of my Biological Basis of Neurological Disorders professor.

He presented us with a case: Following a domestic dispute while at his wedding reception, a 23 year old male presents to the ER with a deep laceration to the neck with the wound toward the back of the head on the right side. X rays are taken. The wound is tended to, the patient is stabilized, and a consultation with the neurosurgeon is called. The neurosurgeon waits for a one-week follow up. On follow-up, the patient’s right leg is diffusely weak but can be elevated with great effort. His right arm has no antigravity strength. Pin-prick testing shows a complete loss of pain sensation on the left side of his body up to his clavicle and shoulder. He completely lacks proprioception and two-point tactile sensation in the fingers and elbow on the right side, and has a significant loss of proprioception and touch at the right great toe, ankle and knee. His right leg and arm are also hyperreflexic. 

Diagnosis:  Brown Sequard Syndrome (hemisection lesion of the cervical spinal cord), which results from right spinothalamic, right corticospinal, and right dorsal column/medial lemniscus lesioning (from the knife insult). This will result in the, observed, ipsilateral motor paralysis, contralateral deficit in pain and temperature sensation, and ipsilateral deficit for touch and proprioception. 

Backstory: This man had been married for approximately two hours. During the wedding reception he cheated on his wife in the kitchen of the reception location. She found him, grabbed a knife, stabbed his neck so strongly that the tip of the knife broke off and remained in his spinal cord, wedged between two vertebrae. The result? He is still alive, and partially permanently paralyzed.

And “the morals of the story,” according to my professor were:

1. don’t get married.
2. don’t have knives.
3. don’t get caught.

I love this class.