title: Cranial migration of a baclofen pump catheter associated with subarachnoid hemorrhage: case report.
abstract: OBJECTIVE
  Cephalad migration of an indwelling intrathecal catheter within the spinal canal has rarely been described. Cranial subarachnoid hemorrhage (SAH) related to movement of this type of catheter has not been described. We report a case of SAH coincident with the migration of a free fragment of a baclofen pump catheter into the prepontine cistern.
  
  
  METHODS
  A baclofen pump system was removed from a 47-year-old man with spasticity related to multiple sclerosis. A section retained in the spinal canal extended up to the T9 level. Ten days after the pump and lower portion of the catheter were removed, the patient presented with a severe headache and a classic aneurysmal pattern of SAH. The patient's catheter was found to have migrated adjacent to the basilar artery at the level of the superior cerebellar artery. An extensive evaluation, including computed tomography angiography, digital subtraction angiography performed twice, magnetic resonance imaging, and magnetic resonance angiography, showed no apparent cause for the hemorrhage. Initially, the catheter was left in place. However, 5 months after the SAH, the patient elected to have the catheter removed.
  
  
  METHODS
  The catheter was pulled out from below through a C6-C7 laminoplasty without complications. The patient made an excellent recovery.
  
  
  CONCLUSIONS
  Cephalad catheter migration is a rare phenomenon. The mechanism of rostral migration remains unclear. The forces that propel a free fragment of catheter under these circumstances seem to be sufficient to cause a small vessel to rupture and bleed. Given the lack of an observed arterial injury, we postulate that venous bleeding caused this hemorrhage.
authors.affiliation: Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona 85013, USA. neuropub@chw.edu
authors.forename: Peter
authors.initials: P
authors.lastname: Nakaji
authors.forename: Giac D
authors.initials: GD
authors.lastname: Consiglieri
authors.forename: Mark P
authors.initials: MP
authors.lastname: Garrett
authors.forename: Nicholas C
authors.initials: NC
authors.lastname: Bambakidis
authors.forename: Andrew G
authors.initials: AG
authors.lastname: Shetter
mesh_terms: D001418:Baclofen / Q000008:administration & dosage; D005548:Foreign-Body Migration / Q000150:complications*; D006801:Humans; D018810:Magnetic Resonance Angiography / Q000379:methods; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D008875:Middle Aged; D009103:Multiple Sclerosis / Q000188:drug therapy; D009125:Muscle Relaxants, Central / Q000008:administration & dosage; D013345:Subarachnoid Hemorrhage / Q000209:etiology* / Q000601:surgery*; D014057:Tomography, X-Ray Computed / Q000379:methods; D014696:Ventriculostomy / Q000379:methods*
chemical_list: D009125:Muscle Relaxants, Central; D001418:Baclofen