Open AccessEmergent Intrathecal Baclofen Withdrawal After Pseudomeningocele Aspiration
Author(s) -
Timothy R. Smith,
Divakar S. Mithal,
Anne Park,
Angela M. Bohnen,
Joseph G. Adel,
Joshua M. Rosenow
Publication year - 2013
Publication title -
pain physician
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.31
H-Index - 99
eISSN - 2150-1149
pISSN - 1533-3159
DOI - 10.36076/ppj.2013/16/e113
Subject(s) - medicine , baclofen , intrathecal , anesthesia , pseudomeningocele , surgery , agonist , complication , receptor
Intrathecal baclofen (ITB) infusion has become a common treatment for severe spasticity.Many complications of these drug delivery systems have been reported such as thoserelated to improper dosing, mechanical failure of the implanted pump or catheter, or postoperative wound issues. We report a case of ITB withdrawal after pseudomeningoceleaspiration. A 21 year-old male with spastic quadriparesis due to traumatic brian injury (TBI)presented with a pseudomeningocele surrounding an ITB pump (215 mcg/day, continuous)implanted in the abdomen. The pseudomeningocele was percutaneously aspirated andapproximately 15 hours later the patient developed signs and symptoms of acute baclofenwithdrawal. As a result, the patient underwent an exploration of the ITB infusion systemwith an intraoperative epidural blood patch. The symptoms of ITB withdrawal improved overthe next 18 hours. The subcutaneous cerebrospinal fluid (CSF) collection partially recurred48 hours later, but this resolved after a second epidural blood patch. The case illustrates aunique presentation of a serious complication of ITB infusion. This underscores that timelydiagnosis and treatment of acute baclofen withdrawal is key to optimal outcomes.Key words: Intrathecal baclofen, baclofen withdrawal, intrathecal baclofen pumpcomplications, pseudomeningocele, cerebrospinal fluid leak, case report