Segura Bruna N, Munteis Olivas E, Gálvez Ruiz A, Pont Sunyer C, Rodríguez Campello A
Servicio de Neurología, Hospital del Mar, Barcelona.
Neurologia. 2009 Mar;24(2):133-5.
Hypoxic-ischemic encephalopathy can lead to different clinical presentations, such as bilateral cortical borderzone infarctions due to cerebral hypoperfusion (especially after cardiopulmonary arrest), which would cause a "man-in-the-barrel" syndrome if the anterior circulation is affected. This syndrome has multiple etiologies, both central (bilateral frontal and/or pyramidal decussation lesions and cervical spinal cord lesions) as well as peripheral ones such as multifocal motor neuropathy.
We report the case of a 19-year-old man who developed a "man-in-the-barrel" syndrome with bilateral and proximal upper limb brachial diplegia after bilateral watershed infarctions involving distal fields of the middle and the anterior cerebral artery due to cerebral hypoperfusion in a comatose patient without internal carotid obstruction.
The rate of death in this syndrome is higher than 90% and it predicts a worse outcome in comatose patients. Nevertheless, our patient has had complete clinical improvement.
缺氧缺血性脑病可导致不同的临床表现，如因脑灌注不足（尤其是心肺骤停后）引起的双侧皮质边缘带梗死，如果前循环受到影响，会导致“桶中人”综合征。该综合征有多种病因，包括中枢性病因（双侧额叶和/或锥体交叉病变以及颈髓病变）以及周围性病因，如多灶性运动神经病。
我们报告一例19岁男性患者，该患者因脑灌注不足在无颈内动脉阻塞的昏迷患者中发生双侧大脑中动脉和大脑前动脉远端区域的分水岭梗死，随后出现“桶中人”综合征并伴有双侧近端上肢臂丛性瘫痪。
该综合征的死亡率高于90%，且提示昏迷患者预后较差。然而，我们的患者临床症状已完全改善。
