Man-in-the-Barrel Syndrome and Its Mimics

Authors: Josef Finsterer, MD, PhD


Man-in-the barrel syndrome (MIBS) is a descriptive term for upper limb paraplegia with preserved mobility of head and lower limb muscles without sensory deficits (brachial diplegia, cruciate palsy, and disproportionate weakness of upper vs. lower extremities), suggesting the patient is constrained in a barrel around the trunk, completely prohibiting upper limb movements.1 Originally, the term was reserved for cases due to bilateral frontal lobe lesions.2 Upper limb diplegia due to other causes were regarded as MIBS-mimics. Meanwhile, however, the term also includes all causes of brachial diplegia including cerebral, spinal cord, and peripheral nerve lesions.3

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