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Case Reports
. 2023 Feb 8;85(3):435-438.
doi: 10.1097/MS9.0000000000000135. eCollection 2023 Mar.

'Man-in-the-barrel' syndrome: a case report of bilateral arm paresis following cardiac arrest

Romana Riyaz  1 , Syed A Usaid  1 , Niharikha Arram  2 , Sumalatha Khatroth  3 , Pranita Shah  4 , Abhigan B Shrestha  5
Affiliations
Case Reports

'Man-in-the-barrel' syndrome: a case report of bilateral arm paresis following cardiac arrest

Romana Riyaz et al. Ann Med Surg (Lond). .

Abstract

'Man-in-the-barrel syndrome' (MIBS) is a neurological phenotype with brachial diplegia, normal sensation, and preserved motor function of the lower limb. Severe hypotension leading to watershed infarctions leading to this phenotype has been reported. The pathogenesis of MIBS is believed to be cerebral hypoperfusion leading to border zone infarctions between the territories of the anterior and middle cerebral arteries.

Case report and discussion: A 49-year-old chronic alcoholic hypertensive Indian male was evaluated for barrel syndrome after a cardiac arrest. MRI confirmed hyperintensities between the territories of the anterior and middle cerebral arteries bilaterally.

Conclusion: Person in barrel syndrome is a rare neurological syndrome. MIB is common after cerebral hypoperfusion and carries a poor prognosis. Identification of the underlying cause is important because the management and prognosis vary based on the etiology.

Keywords: brachial diplegia; cardiac arrest; man-in-a-barrel syndrome.

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Conflict of interest statement

There are no conflicts of interest.Sponsorships or competing interests that may be relevant to content are disclosed at the end of this article.

Figures

Figure 1
Figure 1
Plain MRI of the brain showing hyperintensity in bilateral watershed infarcts between bilateral anterior cerebral artery and middle cerebral artery territories.
Figure 2
Figure 2
Plain MRI of the brain showing bilateral watershed infarcts between bilateral anterior cerebral artery and middle cerebral artery territories.
Figure 3
Figure 3
Anatomical area of the brain with watershed zones. ACA, anterior cerebral artery; MCA, middle cerebral artery; PCA, posterior cerebral artery.
See this image and copyright information in PMC

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