A patient has a Brown-Séquard syndrome at T6 on the right. Which combination of deficits is expected at the level T8 (two segments below the lesion)?

• A Ipsilateral (right) loss of proprioception and vibration; contralateral (left) loss of pain and temperature; ipsilateral upper motor neuron signs below T6 ✓
• B Bilateral loss of pain and temperature at T8 with ipsilateral proprioception loss below T6
• C Ipsilateral loss of all modalities below T6 with contralateral spastic paralysis
• D Contralateral loss of proprioception and vibration; ipsilateral loss of pain and temperature below T6

Explanation

Brown-Séquard syndrome (hemisection of the spinal cord) produces a characteristic cross-pattern. Ipsilateral to the lesion: (1) upper motor neuron signs (spasticity, hyperreflexia) below lesion due to ipsilateral corticospinal tract damage; (2) loss of proprioception and vibration below lesion due to ipsilateral dorsal column damage (fibres that ascend ipsilaterally before crossing in the medulla). Contralateral to the lesion: loss of pain and temperature 2-3 segments below lesion because the spinothalamic tract fibres cross within 2-3 segments of entry before ascending in the contralateral anterolateral column. Option D reverses the proprioception/pain localisation, which is incorrect.

Reference: Guyton & Hall, Textbook of Medical Physiology, 14th ed.

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