"man-in-a-barrel" syndrome

Q: What is "man-in-a-barrel" type stroke or syndrome?

Answer: Infarction of the brain's watershed areas

Hospitalists and intensivists see a lot more patients with systemic hypoperfusion, particularly after 'code' or severe circulatory shock, for various reasons. Circulatory shock in combination with generalized body hурοxemiа may make it worse.

Systemic hypoperfusion, as expected, is more global and does not affect isolated regions. Symptoms are usually diffuse, nonfocal, and bilateral, although they may be asymmetric when there is preexisting vascular occlusion.

The most severe ischemia between the major cerebral supply arteries is known as the border zone or watershed area. The major signs include cortical bliոdոеss, manifesting as bilateral visual loss, stսpοr and weakness of the shoulders and thighs but sparing of the face, hands, and feet - a pattern likened to a "man-in-a-barrel."

#neurology

References:

1. Dogariu OA, Dogariu I, Vasile CM, Berceanu MC, Raicea VC, Albu CV, Gheonea IA. Diagnosis and treatment of Watershed strokes: a narrative review. J Med Life. 2023 Jun;16(6):842-850. doi: 10.25122/jml-2023-0127. PMID: 37675172; PMCID: PMC10478671.

2. Weill C, Suissa L, Darcourt J, Mahagne MH. The Pathophysiology of Watershed Infarction: A Three-Dimensional Time-of-Flight Magnetic Resonance Angiography Study. J Stroke Cerebrovasc Dis. 2017 Sep;26(9):1966-1973. doi: 10.1016/j.jstrokecerebrovasdis.2017.06.016. Epub 2017 Jul 8. PMID: 28694111.