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 Man-in-the-barrel syndrome (MIBS) is a clinical syndrome of bilateral upper extremity paresis with intact motor functioning of the lower extremities, giving the appearance of being confined within a barrel. The pathogenesis of MIBS is believed to be cerebral hypoperfusion leading to border zone infarctions between the territories of the anterior and middle cerebral arteries.<Arch Phys Med Rehabil. 1991 Nov;72(12):1021-3>