Too Aggressive Drop in Blood Pressure in a Hypertensive Male Leading to “Man-in-the-Barrel Syndrome”
Introduction. “Man-in-the-barrel syndrome” is a neurological phenotype with brachial diplegia, normal sensation, and preserved motor function of the lower limb. It has been described in various neuropathological conditions affecting the cerebral hemispheres, pons, upper spinal cord, and peripheral n...
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| Format: | Article |
| Language: | English |
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Wiley
2020-01-01
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| Series: | Case Reports in Neurological Medicine |
| Online Access: | http://dx.doi.org/10.1155/2020/8855574 |
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| author | Chamara Dalugama Achila Jayasinghe Udaya Ralapanawa Shamali Abeygunawardena Thilak Jayalath |
| author_facet | Chamara Dalugama Achila Jayasinghe Udaya Ralapanawa Shamali Abeygunawardena Thilak Jayalath |
| author_sort | Chamara Dalugama |
| collection | DOAJ |
| description | Introduction. “Man-in-the-barrel syndrome” is a neurological phenotype with brachial diplegia, normal sensation, and preserved motor function of the lower limb. It has been described in various neuropathological conditions affecting the cerebral hemispheres, pons, upper spinal cord, and peripheral neurons. Severe hypotension leading to watershed infarctions leading to this phenotype has been reported. We describe the first case of “man-in-the-barrel syndrome” in a patient with a precipitous drop in blood pressure following oral antihypertensive medications. Case Presentation. A 75-year-old Sri Lankan male presented following a generalized tonic-clonic seizure to a tertiary care hospital. Upon recovery, he was noted to have severe brachia diplegia affecting shoulder movements with preserved hand muscle power and motor functions of the lower limb. The previous day, he was newly diagnosed with markedly elevated blood pressure without acute end organ involvement. Treatment with three antihypertensives had been initiated. Noncontrast CT of the brain revealed watershed infarctions affecting both cerebral hemispheres. Conclusion. It is generally unwise to lower blood pressure very rapidly, as ischemic damage can occur in vascular beds that are habituated to high levels of blood pressure in the brain. Ischemic damage caused by rapid lowering of blood pressure may rarely result in “man-in-the-barrel syndrome” leading to severe functional disability. |
| format | Article |
| id | doaj-art-158dc82b76ed4493b08f687a560b7a8c |
| institution | Kabale University |
| issn | 2090-6668 2090-6676 |
| language | English |
| publishDate | 2020-01-01 |
| publisher | Wiley |
| record_format | Article |
| series | Case Reports in Neurological Medicine |
| spelling | doaj-art-158dc82b76ed4493b08f687a560b7a8c2025-02-03T05:53:53ZengWileyCase Reports in Neurological Medicine2090-66682090-66762020-01-01202010.1155/2020/88555748855574Too Aggressive Drop in Blood Pressure in a Hypertensive Male Leading to “Man-in-the-Barrel Syndrome”Chamara Dalugama0Achila Jayasinghe1Udaya Ralapanawa2Shamali Abeygunawardena3Thilak Jayalath4Department of Medicine, University of Peradeniya, Peradeniya, Sri LankaTeaching Hospital, Peradeniya, Sri LankaDepartment of Medicine, University of Peradeniya, Peradeniya, Sri LankaDepartment of Medicine, University of Peradeniya, Peradeniya, Sri LankaDepartment of Medicine, University of Peradeniya, Peradeniya, Sri LankaIntroduction. “Man-in-the-barrel syndrome” is a neurological phenotype with brachial diplegia, normal sensation, and preserved motor function of the lower limb. It has been described in various neuropathological conditions affecting the cerebral hemispheres, pons, upper spinal cord, and peripheral neurons. Severe hypotension leading to watershed infarctions leading to this phenotype has been reported. We describe the first case of “man-in-the-barrel syndrome” in a patient with a precipitous drop in blood pressure following oral antihypertensive medications. Case Presentation. A 75-year-old Sri Lankan male presented following a generalized tonic-clonic seizure to a tertiary care hospital. Upon recovery, he was noted to have severe brachia diplegia affecting shoulder movements with preserved hand muscle power and motor functions of the lower limb. The previous day, he was newly diagnosed with markedly elevated blood pressure without acute end organ involvement. Treatment with three antihypertensives had been initiated. Noncontrast CT of the brain revealed watershed infarctions affecting both cerebral hemispheres. Conclusion. It is generally unwise to lower blood pressure very rapidly, as ischemic damage can occur in vascular beds that are habituated to high levels of blood pressure in the brain. Ischemic damage caused by rapid lowering of blood pressure may rarely result in “man-in-the-barrel syndrome” leading to severe functional disability.http://dx.doi.org/10.1155/2020/8855574 |
| spellingShingle | Chamara Dalugama Achila Jayasinghe Udaya Ralapanawa Shamali Abeygunawardena Thilak Jayalath Too Aggressive Drop in Blood Pressure in a Hypertensive Male Leading to “Man-in-the-Barrel Syndrome” Case Reports in Neurological Medicine |
| title | Too Aggressive Drop in Blood Pressure in a Hypertensive Male Leading to “Man-in-the-Barrel Syndrome” |
| title_full | Too Aggressive Drop in Blood Pressure in a Hypertensive Male Leading to “Man-in-the-Barrel Syndrome” |
| title_fullStr | Too Aggressive Drop in Blood Pressure in a Hypertensive Male Leading to “Man-in-the-Barrel Syndrome” |
| title_full_unstemmed | Too Aggressive Drop in Blood Pressure in a Hypertensive Male Leading to “Man-in-the-Barrel Syndrome” |
| title_short | Too Aggressive Drop in Blood Pressure in a Hypertensive Male Leading to “Man-in-the-Barrel Syndrome” |
| title_sort | too aggressive drop in blood pressure in a hypertensive male leading to man in the barrel syndrome |
| url | http://dx.doi.org/10.1155/2020/8855574 |
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