Two Cases of ‘Man-in-the-Barrel’ Syndrome Caused by Cerebral Hypoperfusion and Hypoxia

Abstract

Background: Man-in-the-barrel syndrome (MIBS) is defined as brachial diplegia with normal strength in the legs. Most common cause of MIBS is borderzone ischemia resulting from cerebral hypoperfusion. Case Report: Our first patient was a 61-year-old woman who had cardiac arrest during medical procedure in a hospital. After resuscitation, she developed a comatous mental status. Our second patient was a 78-year-old man who was admitted with pneumonia. During hospitalization, he was discovered in an unconsciousness state. After emergent treatment, he developed a status myoclonus. After multiple antiepileptic drugs trials, his seizure attacks stopped. In both cases, mental status was recovered. However, motor weakness confined to bilateral upper extremities with preserved lower extremities strength persisted. Magnetic resonance image showed bilateral hyperintense lesions in arm-hands area of motor cortex. After supportive care, there was partial improvement in upper extremities strength. Conclusion: MIBS after cerebral hypoperfusion usually has poor outcome with high mortality rate. However, our cases had relatively good recovery. This might be due to prompt recognition, resuscitation, and treatment after hypoxic attack.

Keywords

• Brachial diplegia
• Man-in-the-barrel syndrome
• Borderzone infarction