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Updated: Jun 24, 2026
08:47
The Hypoxic Ischemic Encephalopathy Model of Perinatal Ischemia
Published on: November 19, 2008
[Reversible "man-in-the-barrel" syndrome caused by hypoxic-ischemic encephalopathy]
N Segura Bruna1, E Munteis Olivas, A Gálvez Ruiz
1Servicio de Neurología, Hospital del Mar, Barcelona. 94407@imas.imim.es
Neurologia (Barcelona, Spain)
|March 27, 2009
Summary
Hypoxic-ischemic encephalopathy can cause "man-in-the-barrel" syndrome, a severe neurological condition. This case report details a young patient’s unexpected full recovery, defying the syndrome’s typically poor prognosis.
Area of Science:
- Neurology
- Neuroscience
- Clinical Medicine
Background:
- Hypoxic-ischemic encephalopathy (HIE) can manifest as bilateral watershed infarctions, particularly in the anterior circulation territories.
- These infarctions can lead to "man-in-the-barrel" syndrome, characterized by specific neurological deficits.
- The syndrome has diverse central and peripheral etiologies and is associated with high mortality.
Observation:
- A 19-year-old male presented with "man-in-the-barrel" syndrome.
- The syndrome presented as bilateral proximal upper limb brachial diplegia.
- This occurred secondary to bilateral watershed infarctions in the anterior and middle cerebral artery distal fields due to cerebral hypoperfusion.
Findings:
- The patient experienced bilateral watershed infarctions without internal carotid artery obstruction.
- The clinical presentation was consistent with "man-in-the-barrel" syndrome.
- Despite the syndrome's grave prognosis, complete clinical improvement was observed.
Implications:
- "Man-in-the-barrel" syndrome, often linked to HIE, carries a mortality rate exceeding 90%.
- This case highlights the possibility of significant recovery even in severe neurological injury.
- The findings suggest potential for better outcomes in select patients with cerebral hypoperfusion-induced watershed infarctions.
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