Man-in-the-Barrel Syndrome Secondary to Idiopathic Acute Anterior Spinal Artery Infarction.

A 52-year-old female presented to our hospital with an acute history of isolated bilateral arm weakness. An MRI of the cervical spine confirmed an acute anterior spinal artery infarction. Further investigations to determine a specific etiology were unremarkable, leading to a diagnosis of idiopathic anterior spinal artery infarction consistent with Man-in-the-Barrel syndrome.

Person-in-the-barrel syndrome following cervical spine surgery: illustrative case.

BACKGROUND: Person-in-the-barrel syndrome is characterized by bilateral brachial diplegia, intact cranial nerves, and preserved lower-extremity strength. Most cases are due to bilateral supratentorial brain lesions at the border zone of the anterior and middle cerebral artery vascular territories. This condition has been observed with spinal pathology, primarily involving vascular dissection and thromboembolism. OBSERVATIONS: The authors' case is the first in the literature to highlight person-in-the-barrel syndrome immediately following cervical spine surgery. Weakness of the deltoids, biceps, infraspinatus, and brachioradialis was observed bilaterally postoperatively. Electromyograph (EMG)-nerve conduction velocity (NCV) studies revealed a cervical radiculopathy involving C5 and C6 bilaterally with denervation of the deltoids, biceps, and brachioradialis. Within 8 months of cervical spine surgery, the patient regained improvement of the bilateral brachial diplegia. LESSONS: EMG/NCV studies play a valuable role in detecting cervical radiculopathy after cervical spine surgery in patients with bilateral brachial diplegia. The authors postulate that this condition may have occurred following neck hyperextension during cervical cage placement, increasing the foraminal stenosis at C4-5 and C5-6 and worsening the C5 and C6 radiculopathy. Spinal surgeons should be cognizant of person-in-the-barrel syndrome that may ensue following cervical spine surgery and promptly identify and treat this condition to offer the best prognosis for a favorable patient outcome.

Man-In-The-Barrel Syndrome: Acute bilateral brachial plexopathy after recurrent microtrauma.

The presence of brachial diplegia despite the normal muscular strength of the lower extremities is called the man-in-the-barrel syndrome (MIBS). Although this rare syndrome often occurs due to the bilateral supratentorial brain lesions, it may also rarely occur as a result of infratentorial causes. In this report, we describe a case presenting with MIBS of which etiological underlying cause was bilateral brachial plexopathy developed secondarily to recurrent microtrauma. A 51-year-old male patient presented to our clinic with complaints of pain and weakness on both arms. After electrodiagnostic examination, bilateral brachial plexopathy was identified. The findings of the patient improved following methylprednisolone therapy. It is very important to determine the treatable causes of this syndrome at an early stage.

"Man in the Barrel" Syndrome with Anterior Spinal Artery Infarct due to Vertebral Artery Dissection.

BACKGROUND: Man in the barrel syndrome (MBS) is a condition of brachial diplegia initially described after a bilateral watershed cerebral infarct between the anterior and the middle cerebral artery territories. OBJECTIVE: To report a case of MBS as a consequence of anterior spinal artery infarct due to vertebral artery dissection. DISCUSSION: More recently, nonischemic lesions in brain and brain stem have also been described as etiologies of MBS. There are few reports describing spinal cord infarction leading to MBS. The anterior spinal artery syndrome with only brachial diplegia also represents a rare and atypical pattern. CONCLUSION: The conventional neurological consideration that MBS provides a precise anatomical localization is now challenged. The finding of a brachial diplegia leads to the need to investigate the brain, the spinal cord, and the peripheral nervous system.

Reversible man-in-the-barrel syndrome in myasthenia gravis.

Man-in-the-barrel syndrome (MBS) is an uncommon presentation due to bilateral, predominantly proximal muscle weakness that has not been described to be associated with myasthenia gravis. We describe a case of myasthenia gravis presenting as MBS. Additionally, he had significant wasting of the deltoids bilaterally with fibrillations on electromyography (EMG) at rest and brief duration (3-6 ms) bi/triphasic motor unit potentials (MUPs) on submaximal effort apart from a decremental response on repetitive nerve stimulation (RNS) at 2 Hz. While electrophysiology is an important tool in the diagnosis of myasthenia gravis, pathological EMG patterns do not exclude the diagnosis of myasthenia gravis.

A Case of Man-in-the-Barrel Syndrome Induced by Cervical Spinal Cord Ischemia / 대한임상신경생리학회지

Man-in-the-barrel syndrome (MIBS) is a clinical syndrome of bilateral upper limb weakness with normal lower extremity function. It can be caused by various neurological conditions such as bilateral cerebral hypoperfusion, syringomyelia, motor neuron disease, or cervical myelopathies. We report a patient with MIBS after cervical spinal cord ischemia. It is postulated to be caused by ischemic insults of anterior spinal artery from repeated and prolonged neck extension.

Man-in-the-barrel syndrome, a symmetrical proximal brachial amyotrophic diplegia related to motor neuron diseases: a survey of nine cases / Síndrome do homem no barril, uma diplegia amiotrófica braquial proximal simétrica relacionada a doença do neurônio motor: a propósito de nove casos

OBJECTIVE: To report on 9 patients presenting with sporadic motor neuron disease , who over a long period of time evolved with a symmetrical proximal brachial amyotrophic diplegia. METHODS: Nine patients were followed-up who , displayed, since onset, a progressive limitation of arm flexion/abduction resulting in a peculiar posture with both hands hanging loosely beside the trunk. Electrophysiological test results were consistent with lower motor neuron disease. Cervical MRI was performed in all patients. RESULTS: Nine male subjects with ages ranging from 38 to 73 years at onset of symptoms, developed bilateral and symmetric paresis and atrophy of upper limb muscles. Proximal muscles were more involved than the distal groups. In most patients tendon reflexes were absent or hypoactive in the upper limbs. Needle electromyography (EMG) revealed positive sharp waves and fibrillations and high amplitude polyphasic potentials with an incomplete recruitment pattern in most upper limb muscles. EMG of lower limb muscles was normal in some cases while abnormal in others. MRC did not disclose cervical spinal cord abnormalities from C5-T1. CONCLUSION: Attention is called to the Man-in-the-Barrel syndrome in some motor neuron diseases, especially in patients with progressive spinal atrophy and amyotrophic lateral sclerosis.

OBJETIVO: Relatar nove pacientes com a doença do neurônio de motor esporádica que apresentam progressiva e simétrica diplegia braquial amiotrófica. MÉTODOS: Acompanhamos nove pacientes que exibiram, desde o começo, uma limitação progressiva de flexão/abdução do membro superior resultando em uma postura peculiar com ambas as mãos pendentes ao longo do tronco. Os resultados dos testes eletrofisiológicos foram consistentes com achados de doença do neurônio motor inferior. Ressonância magnética (RM) cervical foi realizada em todos pacientes. RESULTADOS: Nove pacientes do sexo masculino com idades entre 38-73 anos no início dos sintomas desenvolveram paresia e a atrofia bilateral simétrica dos músculos dos membros superiores. Os músculos proximais foram mais comprometidos do que os distais. Os reflexos tendíneos dos membros superiores encontravam-se abolidos ou hipoativos na maioria dos pacientes. A eletromiografia (EMG) revelou ondas positivas, fibrilações e potenciais polifásicos de alta amplitude com padrão incompleto de recrutamento na maioria dos músculos dos membros superiores. A EMG dos membros inferiores foi normal em alguns casos e anormal em outros. A RM não evidenciou anormalidades da medula espinhal cervical de C5-T1. CONCLUSÃO: Atentamos para a síndrome do homem do Barril em algumas doenças do neurônio de motor, especialmente na atrofia espinhal progressiva e esclerose lateral amiotrófica.

Síndrome do homem no barril doenças do neurônio motor: a propósito de 5 casos / Man-in-the-barrel syndrome in motor neuron disease: on purpose of 5 cases

A Síndrome do Homem no Barril (SHB) faz referência a um quadro de paresia/plegia braquial bilateral que influencia na execução de funções relacionadas aos membros superiores, principalmente as que requerem movimentos de flexão e abdução. Desde sua descrição inicial, inúmeros casos foram relatados de pacientes com essa síndrome, cuja etiopatogenia difere daquela descrita inicialmente. Apresentamos 5 casos de SHB relacionados a doenças do neurônio motor e, discutimos, com base na literatura vigente, os achados do exame neurológico, prejuízosfuncionais e exames complementares. As mais frequentes causas de SHB são distúrbios vasculares cerebrais, cirurgias cardíaca e extracardíaca com demonstração de hipotensão arterial, metásteses cerebrais, e o envolvimento da ponte e medula espinhal cervical. O substrato fisiopatológico que se relaciona a SHB, em alguns casos, é incerto e merece atenção. Atentamos para a SHB em determinadas doenças do neurônio motor, principalmente nas Amiotrofias Espinhais Progressivas e na Esclerose Lateral Amiotrófica.

The Man-in-the-Barrel syndrome (MBS) makes reference to a picture of bilateral brachial weakness/paralysis, that influences the patients in the execution of functions related with the upper limbs, mainly those that require flexion and abduction movement. Since its initial description, several cases were reported of patients with this syndrome, whose etiology differs from the first one described. We present 5 cases of MBS related to motor neuron diseases, and discuss, based on the literature, the findings of the neurological examination, functional impairments and complementary exams. The most frequent causes of MBS are cerebral vascular disorders, cardiac and extracardiac surgeries with demonstration of arterial hypotension, cerebral metastases, pontine and spinal cord involvement. The pathophysiological substratum related to MBS, in some cases, is uncertain and deserves attention. We call the attention to MBS in some motor neuron disease, especially in Progressive Spinal Atrophy and Amyotrophic Lateral Sclerosis.