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Background <p>Person-in-the-barrel syndrome (PIBS) describes an isolated, usually symmetrical weakness of the proximal arm muscles, with preserved function of the lower limbs and facial muscles. The syndrome does not represent a&#xa0;distinct disease entity, but rather a&#xa0;topographically defined clinical phenotype resulting from damage along the motor pathways at the cerebral, spinal or peripheral level. Its manifestation in the context of giant cell arteritis (GCA) is extremely rare.</p> Case report <p>We report on a&#xa0;77-year-old woman presenting with new-onset bilateral proximal upper limb weakness against a&#xa0;background of systemic signs of inflammation. Clinically and electromyographically, the findings were consistent with bilateral plexopathy of the superior trunk (C5–C6), whilst sensation was largely preserved. Duplex sonography revealed typical halo signs of the temporal artery, confirming the diagnosis of GCA.</p> Discussion <p>The literature indicates that PIBS in GCA is predominantly caused by vasculitis of the large supra-aortic vessels, leading to ischaemic plexopathy. Sensation may be preserved or impaired, depending on the extent of plexus involvement.</p> Conclusion <p>In patients with GCA, a&#xa0;neurological manifestation in the form of PIBS should be considered as a&#xa0;cause of bilateral arm paresis.</p>

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Gefangen im Fass – wenn die Arme versagen

  • 期刊论文

  • 发表日期：

    2026年5月5日

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  • Fabian Brennecke,
  • Samuel Rubeli,
  • Sebastian Finkener,
  • Sabine Adler

摘要

Background

Person-in-the-barrel syndrome (PIBS) describes an isolated, usually symmetrical weakness of the proximal arm muscles, with preserved function of the lower limbs and facial muscles. The syndrome does not represent a distinct disease entity, but rather a topographically defined clinical phenotype resulting from damage along the motor pathways at the cerebral, spinal or peripheral level. Its manifestation in the context of giant cell arteritis (GCA) is extremely rare.

Case report

We report on a 77-year-old woman presenting with new-onset bilateral proximal upper limb weakness against a background of systemic signs of inflammation. Clinically and electromyographically, the findings were consistent with bilateral plexopathy of the superior trunk (C5–C6), whilst sensation was largely preserved. Duplex sonography revealed typical halo signs of the temporal artery, confirming the diagnosis of GCA.

Discussion

The literature indicates that PIBS in GCA is predominantly caused by vasculitis of the large supra-aortic vessels, leading to ischaemic plexopathy. Sensation may be preserved or impaired, depending on the extent of plexus involvement.

Conclusion

In patients with GCA, a neurological manifestation in the form of PIBS should be considered as a cause of bilateral arm paresis.