Man-in-the-barrel syndrome (MIBS) is a rare neurological condition characterized by bilateral upper limb weakness with preserved lower extremity and bulbar strength, drawing a parallel to the feeling of being 'stuck in a barrel'. It is caused by bilateral symmetric injury to the motor fibers specifically responsible for arm movement. This syndrome can result from various neurological conditions, including an anterior spinal artery infarction which disrupts blood flow to the spinal cord.

We present a 52-year-old female who came to our hospital with an acute history of isolated bilateral arm weakness. Neurological examination confirmed significant upper extremity weakness with an intact lower extremity examination. An MRI of the cervical spine revealed an acute infarction in the anterior spinal artery affecting the C6-T1 segments, however further investigations to determine a specific etiology were negative.

This case report underscores the rarity of man-in-the-barrel syndrome (MIBS) in the context of spinal cord infarction, specifically highlighting our patient’s unusual presentation resulting from an idiopathic cervical anterior spinal artery infarction—a scenario rarely documented in the medical literature.

Recognizing this syndrome through a comprehensive neurological evaluation and imaging studies is crucial for timely intervention, which can significantly impact patient outcomes.