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An unusual cause of overdose after baclofen pump implantation: case report. Neurosurgery 2005 Mar;56(3):E624; discussion E624

Date

02/26/2005

Pubmed ID

15730591

DOI

10.1227/01.NEU.0000154133.49781.66

Scopus ID

2-s2.0-14644395496   21 Citations

Abstract

OBJECTIVE AND IMPORTANCE: Intrathecal baclofen delivery for the treatment of spasticity has been used for almost 20 years with a great deal of success. A wide variety of complications and pitfalls have been described. This report details a novel complication involving inadvertent and initially unrecognized canalization of the subdural space with the spinal catheter, which ultimately resulted in an overdose.

CLINICAL PRESENTATION: An intrathecal pump system was implanted in a 15-year-old girl with spasticity. This initially resulted in a lack of therapeutic effect. The diagnostic workup ultimately led to contrast administration through the pump system, which precipitated a baclofen overdose when sequestered medication in the subdural compartment was released into the intrathecal space.

INTERVENTION: The spinal catheter was subsequently revised, and the patient made a full recovery.

CONCLUSION: The possibility of a subdural catheter should be included in the differential diagnosis in patients who experience a lack of drug effect after pump implantation, despite increases in dosage. Close monitoring is required because of the risk of spontaneous or induced overdose, which may occur when a communication develops between the subdural and intrathecal compartments.

Author List

Lew SM, Psaty EL, Abbott R

Author

Sean Lew MD Chief, Professor in the Neurosurgery department at Medical College of Wisconsin




MESH terms used to index this publication - Major topics in bold

Adolescent
Baclofen
Cerebral Palsy
Consciousness Disorders
Contrast Media
Drug Overdose
Dystonic Disorders
Equipment Failure
Female
Humans
Hypotension
Hypoventilation
Infusion Pumps, Implantable
Injections, Spinal
Iohexol
Muscle Hypotonia
Muscle Spasticity
Parasympatholytics
Respiration, Artificial
Subdural Space