Man-in-the-barrel syndrome caused by a pontine lesion

Abstract

Abstract-Objective:To examine whether the presence of motor signs has predictive value for important outcomes in Alzheimer disease (AD). Methods: A total of 533 patients with AD at early stages (mean Folstein Mini-Mental State Examination [MMSE] 21/30 at entry) were recruited and followed semiannually for up to 13.1 years (mean 3) in five University-based AD centers in the United States and European Union. Four outcomes, assessed every 6 months, were used in Cox models: cognitive endpoint (Columbia Mini-Mental State Examination Յ 20/57 [‫ف‬MMSE Յ 10/30]), functional endpoint (Blessed Dementia Rating Scale Ն 10), institutionalization equivalent index, and death. Using a standardized portion of the Unified PD Rating Scale (administered every 6 months for a total of 3,149 visit-assessments, average 5.9 per patient), the presence of motor signs, as well as of individual motor sign domains, was examined as time-dependent predictor. The models controlled for cohort, recruitment center, sex, age, education, a comorbidity index, and baseline cognitive and functional performance. Results: A total of 39% of the patients reached the cognitive, 41% the functional, 54% the institutionalization, and 47% the mortality endpoint. Motor signs were noted for 14% of patients at baseline and for 45% at any evaluation. Their presence was associated with increased risk for cognitive decline (RR, 1.72; 95% CI, 1.24 to 2.38), functional decline (1.80 [1.33 to 2.45]), institutionalization (1.68 [1.26 to 2.25]), and death (1.38 [1.05 to 1.82]). Tremor was associated with increased risk for reaching the cognitive and bradykinesia for reaching the functional endpoints. Postural-gait abnormalities carried increased risk for institutionalization and mortality. Faster rates of motor sign accumulation were associated with increased risk for all outcomes. Conclusions: Motor signs predict cognitive and functional decline, institutionalization, and mortality in Alzheimer disease. Different motor sign domains predict different outcomes.

‘Man-in-the-Barrel’ Syndrome with Bilateral 6th Cranial Nerve Palsy

“…An MRI of the brain showed aneurysmal compression of the mid-pons. There are reports of ‘man-in-the barrel’ syndrome secondary to osmotic demyelination [1] or ischemic strokes [2] of the pons, but not secondary to pontine compression (fig. 2).…”

Man-in-the-barrel syndrome after thoracoilium fusion

“…An MIB syndrome has been associated with many other clinical phenomena. These cases include brain metastasis, 14 central pontine lesions, 7,16 hemorrhagic shock, 5 hypotension after cardiac surgery, 10,11 traumatic head injury, 6 cardiorespiratory arrest, 18 and glioblastoma multiforme. 4 Some authors have attributed MIB syndrome to cervical spine disease such as anterior cervical artery infarction, 3 cervical metastasis, 20 and motor neuron disease.…”

„Man-in-the-barrel“-Syndrom

“…Dennoch ist das klinische Bild eines akut auftretenden "Man-in-the-barrel"-Syndroms nicht beweisend für bihemisphärische Grenzzoneninfarkte. Kasuistisch wurde das Syndrom auch bei bilateralen Infarkten des Brückenfußes [16] und des zervikalen Myelons [4,17] berichtet. Verletzungen des zervikomedullären Übergangsbereichs im Rahmen von Schädel-Hirn-Trauma, Schussverletzungen etc.…”