Man in a Barrel Syndrome

Man in a barrel syndrome (MIBS) is a neurologic syndrome characterized by weakness in the bilateral upper extremities (brachial diplegia) with preserved strength in the face, neck, and bilateral lower extremities. Clinically a patient appears as though they are "stuck in a barrel" with impaired bilateral arm movement and normal facial, cervical, and lower extremity strength. MIBS can result from bilateral symmetric injury to the brain affecting motor fibers that control arm movement and can also occur following injury to the brainstem, cervical spinal cord, bilateral brachial plexus, or peripheral nerves. Systemic hypotension causing bilateral watershed strokes is a common cause of MIBS. Watershed strokes occur between the "border zones" of the cerebral vascular territories. When blood pressure is low to the point that it is insufficient to supply blood flow to the most distal arterial small vessel branches, these "border zones" do not receive enough oxygenated blood to survive, resulting in cell death. Cardiac arrest, causing impaired blood flow to the brain, can cause MIBS.