title: Microfracture of a baclofen pump catheter with intermittent under- and overdose.
abstract: An 8-year-old boy with an implanted intrathecal baclofen pump presented with intermittent signs of baclofen under- and overdose. Pump interrogation, pump volumes, plain X-rays, catheter contrast fluoroscopy and CT of the intrathecal catheter tip were unremarkable. A microfracture of the extradural catheter was only seen at a magnification of x20 and confirmed by scanning electron microscopy. Symptoms resolved following replacement. Microfracture of the intrathecal catheter of baclofen pump systems may present puzzling symptomatology and be difficult to diagnose by conventional means.
authors.affiliation: Department of Neurosurgery, Hospital for Sick Children, and Bloorview-MacMillan Rehabilitation Center, Toronto, Canada.
authors.forename: William J
authors.initials: WJ
authors.lastname: Dawes
authors.forename: James M
authors.initials: JM
authors.lastname: Drake
authors.forename: Darcy
authors.initials: D
authors.lastname: Fehlings
mesh_terms: D001418:Baclofen / Q000008:administration & dosage*; D002408:Catheters, Indwelling / Q000009:adverse effects*; D002648:Child; D004305:Dose-Response Relationship, Drug; D062787:Drug Overdose / Q000209:etiology; D004868:Equipment Failure; D006801:Humans; D015918:Infusion Pumps, Implantable; D007278:Injections, Spinal / Q000009:adverse effects; D008297:Male; D009125:Muscle Relaxants, Central / Q000008:administration & dosage*
chemical_list: D009125:Muscle Relaxants, Central; D001418:Baclofen