[Postoperative bilateral brachial plexopathy mimicking the "man-in-the-barrel" syndrome]

Abstract

We describe a patient with a postoperative bilateral upper limb palsy due to involvement of the upper trunk of the brachial plexus. The weakness distribution (bilateral upper limb paresis without leg involvement) reminded of the classic "man-in-the-barrel" syndrome, which is usually due to bilateral watershed infarcts of the brain in relation with severe hypotension. Bilateral postoperative brachial plexopathies are very uncommon and should be distinguished from the "man-in-the-barrel" syndrome of "central" origin, since the former bears a much better prognosis and management is different. The mechanisms of plexus damage during surgery, as well as the different etiologies of the "man-in-the-barrel" syndrome, are discussed.