Predicting outcome from coma: man-in-the-barrel syndrome as potential pitfall

The Glasgow coma scale motor score is often used in predicting outcome afte r hypoxic ischemic coma. Judicious care should be exerted when using this v ariable in predicting outcome in patients with coma following hypotension s ince borderzone infarction can obscure the clinical picture. We describe a patient who underwent skull base surgery for a schwannoma of the left facia l nerve. The operation, which lasted for 10 h, was conducted under controll ed hypotension. After the intervention the patient remained comatose with a bsent arm movements upon painful stimuli. An absent motor score usually car ries a poor prognosis. However, magnetic resonance inversion recovery imagi ng of the brain showed bilateral hyperintense lesions in the arm-hand area indicative of borderzone ischemic damage. The patient received optimal supp ortive care and after 17 days he regained consciousness with man-in-the-bar rel syndrome', which also further improved over time. (C) 2000 Elsevier Sci ence B.V. All rights reserved.