title: Subdural catheter migration may lead to baclofen pump dysfunction.
abstract: OBJECTIVE
  To report an unusual cause of intrathecal drug delivery failure in baclofen pump device.
  
  
  METHODS
  A case report of an SCI patient treated with intrathecal baclofen, presenting a drug withdrawal.
  
  
  METHODS
  Regional spinal cord injuries centre in Geneva (Switzerland).
  
  
  METHODS
  We present a case of a 38-year-old male with complete T9 spastic paraplegia for 15 years, treated with intrathecal baclofen for 11 years. He recently presented to our centre with a spastic hypertonic episode, associated with rhabdomyolysis.
  
  
  RESULTS
  Standard investigations were unrevealing. However, a CT scan performed after injecting a radio-opaque solution by the side port of the pump, showed an unexpected catheter migration into the subdural space. Surgical revision reversed withdrawal symptoms.
  
  
  CONCLUSIONS
  Subdural catheter migration must be considered in the differential diagnosis of intrathecal drug delivery system failures. We recommend the use of the CT scan after contrast injection, to detect the localization of the distal catheter tip and confirm the normal diffusion into the subarachnoid space.
authors.affiliation: Spinal Cord Unit, Clinic of Reeducation, Department of Clinical Neuroscience, University Hospital of Geneva, Switzerland.
authors.forename: Y
authors.initials: Y
authors.lastname: Pasquier
authors.forename: A
authors.initials: A
authors.lastname: Cahana
authors.forename: A
authors.initials: A
authors.lastname: Schnider
mesh_terms: D000058:Accidental Falls; D000328:Adult; D001418:Baclofen / Q000008:administration & dosage*; D002404:Catheterization / Q000009:adverse effects*; D004868:Equipment Failure; D005500:Follow-Up Studies; D005548:Foreign-Body Migration / Q000150:complications* / Q000000981:diagnostic imaging / Q000601:surgery; D006801:Humans; D015918:Infusion Pumps, Implantable / Q000009:adverse effects*; D008297:Male; D009125:Muscle Relaxants, Central / Q000008:administration & dosage; D009128:Muscle Spasticity / Q000188:drug therapy; D010264:Paraplegia / Q000175:diagnosis / Q000188:drug therapy; D012047:Rehabilitation Centers; D012086:Reoperation; D018570:Risk Assessment; D013119:Spinal Cord Injuries / Q000175:diagnosis / Q000188:drug therapy*; D013375:Substance Withdrawal Syndrome / Q000209:etiology*; D013904:Thoracic Vertebrae / Q000293:injuries; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
chemical_list: D009125:Muscle Relaxants, Central; D001418:Baclofen