Delayed onset of Brown-Sequard syndrome involving upper extremity pain

Report of a case: A 60-year-old white male with a history of C3-C4 spinal cord injury with subsequent C3-C4 fusion complained of right upper extremity painful spasms of 2 years duration with associated hyperspasticity, motor weakness and poor positional and vibrational sense. The patient was diagnosed with Brown-Sequard syndrome (BSS) and treated with botulinum toxin type A injections distributed into the affected muscle groups that provided substantial and lasting relief. This case is unique in that the patient's trauma occurred 28 years before the development of the BSS suggesting a slow evolution of the condition.