Related Experiment Video
Updated: Sep 7, 2026

Induction of Cerebral Arterial Gas Embolism in Rat
Published on: October 18, 2024
Man-in-the-barrel syndrome caused by cervical arachnoiditis in refractory coccidioidal meningitis
Sophia Marie Pelayo Tran1, Tanya Savenka2, Kwan L Ng3
1University of California Davis Medical School, Sacramento, CA, USA.
Abstract:
We report a case of refractory coccidioidal meningitis presenting with bilateral upper-extremity weakness in a man-in-a-barrel distribution caused by cervical arachnoiditis, adhesive bands, and spinal cord compression. The patient was treated sequentially with fluconazole, other azole therapy, liposomal amphotericin B, intrathecal amphotericin B, and olorofim, with only partial disease control. Neuroimaging demonstrated progressive cervical leptomeningeal inflammation, cord tethering, and CT myelography illustrated adhesive arachnoiditis. Surgical lysis of adhesions and placement of a spinal Ommaya reservoir for intrathecal amphotericin delivery above and below the obstructed segment resulted in partial neurologic improvement. This case broadens the differential diagnosis of man-in-a-barrel syndrome to include active fungal meningitis with compressive cervical myelopathy and highlights the role of combined surgical-medical management in complicated fungal arachnoiditis.
Related Concept Videos
Bacterial Meningitis I: Introduction
Cryptococcal Meningitis
Bacterial Meningitis
Bacterial Meningitis II: Pathophysiology
Viral Meningitis
Cerebral Edema ll: Pathophysiology