Pediatric spinal cord infarct: a rare cause of a rare disorder, (wo)man in barrel syndrome
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CASE REPORT
Pediatric spinal cord infarct: a rare cause of a rare disorder, (wo)man in barrel syndrome Nishtha Yadav 1 & Hima Pendharkar 2 & Girish Baburao Kulkarni 3 Received: 17 April 2020 / Accepted: 12 October 2020 # Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract The “man in barrel syndrome” is a condition which resembles the aspect of patient being constrained in a barrel in which patient presents with bilateral upper limb weakness. It has classically been attributed to supratentorial lesions in watershed zones. We present such a case in a 12-year-old child who presented with bibrachial weakness and was noted to have cervical cord infarct on imaging. Spinal cord infarct is a rare cause of this syndrome, and until now only 20 cases have been described in which cervical cord infarct led to this presentation, all of them being adults. We describe first case report of bibrachial diplegia due to cord infarct in a child. Our case adds to the limited literature of cervical cord ischemia as a cause of “(wo) man in barrel syndrome” and reiterates the fact that imaging of cervical cord should be considered while evaluating these cases. Keywords Man in barrel syndrome . Cervical cord infarct . Spinal cord infarct . Pediatric spinal cord infarction
Introduction The “man in barrel syndrome” is a condition of bibrachial diplegia with bilateral upper limb weakness which resembles the aspect of patient being constrained in a barrel. It has classically been attributed to supratentorial lesions and is most commonly associated with bilateral symmetric watershed ischemia between anterior and middle cerebral arteries. Other causes like metastasis, contusions, and demyelination in the same border zones have also been described as a cause of bibrachial diplegia [1]. This typical presentation with * Hima Pendharkar [email protected] Nishtha Yadav [email protected] Girish Baburao Kulkarni [email protected] 1
Department of Radiology, Super Speciality Hospital, Netaji Subhash Chandra Bose Medical College, Jabalpur, Madhya Pradesh 482003, India
2
Department of Neuroimaging and Interventional Radiology, National Institute of Mental Health and Neurosciences, Bangalore 560029, India
3
Department of Neurology, National Institute of Mental Health and Neurosciences, Bangalore 560029, India
weakness of upper limbs with sparing of lower limbs is caused due to involvement of motor fibers which control arm movement. Apart from supratentorial watershed zones, other sites of involvement may include brainstem, cervical spinal cord, bilateral brachial plexus, or peripheral nerves [2]. Spinal cord infarct is a rare cause of bibrachial diplegia [1, 3, 4]. We report a case of bibrachial diplegia ((wo)man in barrel syndrome) due to cervical cord infarction in a child.
Case report A 12-year-old female child presented with history of sudden onset neck pain radiating to bilateral upper limbs. Within a few minutes, she developed weakness (proximal > distal) and sensory loss of both upper limbs. There was no weakness of
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