Man-in-the-Barrel Syndrome (MIBS) secondary to Cervical Cord Contusion

Muhammad Sohail Ajmal Ghoauri; Nauman Ismat Butt; Hamid Mehmood; Barak Waris

doi:10.5455/CRSM.20251001033558

Abstract
Man-in-the-Barrel Syndrome (MIBS) is a neurological condition characterized by weakness in both upper limbs while face, neck and lower limbs remain unaffected. MIBS can result from cervical cord contusion in the absence of fracture with upper limb corticospinal tracts being especially vulnerable to central cord injury. We report the case of a 35-year-old male who presented with sudden bilateral upper limb weakness after he fell from a height of approximately two meters. Neurological examination revealed motor power in both upper limbs at 2/5 while lower limbs were normal, with exaggerated deep tendon reflexes in the upper limbs. Plantar reflexes were bilaterally upgoing. MRI scan revealed T2 hyperintense signals in the cervical spinal cord, consistent with cervical cord contusion. Based on clinical and radiological findings, a diagnosis of MIBS secondary to cervical cord contusion was made. He was started on intravenous methylprednisolone for five days resulting in notable improvement. Physical and occupational rehabilitation were initiated. This case highlights the importance of recognizing MIBS as a potential complication of spinal trauma, enabling prompt treatment and rehabilitation. Early steroid therapy and rehabilitation may significantly improve outcomes.

Key words: Man-in-the-Barrel Syndrome (MIBS), Cervical Cord Contusion, MRI scan, T2 hyper-intense signals, Rehabilitation, Neurology, Pakistan.