title: Meningismus associated with malpositioned intraspinal catheter for drug delivery.
abstract: BACKGROUND
  Implanted delivery systems for intrathecal drug administration have become more common in the management of nonmalignant pain. Many postprocedural complications have been described in the literature including infection and headache provoked by position changes. Determining the etiology of a postimplant headache is important particularly when considering the possibility of a life-threatening infection.
  
  
  METHODS
  We present a patient who underwent placement of an implantable drug delivery system (IDDS) for intractable abdominal pain that developed positional headaches, and significant neck and back pain. Attempted cerebrospinal fluid aspiration reproduced her symptoms and imaging revealed a malpositioned intraspinal catheter tip approximated to the meninges. Revision of the system completely relieved her symptoms.
  
  
  CONCLUSIONS
  Meningismus from malpositioned catheters is a rare complication that can mimic meningitis but should be considered in the differential for postimplant headaches. Given the increased use of IDDS, it is important to recognize and evaluate postimplant complication and treat it appropriately. We discuss this case report and appropriate work-up and differential diagnosis for meningismus following implant.
authors.affiliation: Mayo Clinic College of Medicine, Rochester, Minnesota 55905, USA. hoelzer.bryan@mayo.edu
authors.forename: Bryan C
authors.initials: BC
authors.lastname: Hoelzer
authors.forename: Sarah L
authors.initials: SL
authors.lastname: Knievel
authors.forename: Whitney B
authors.initials: WB
authors.lastname: Michiels
authors.forename: Gail L
authors.initials: GL
authors.lastname: McGlothlen
authors.forename: Eric J
authors.initials: EJ
authors.lastname: Grigsby
mesh_terms: D015746:Abdominal Pain / Q000188:drug therapy; D000328:Adult; D057785:Catheters / Q000009:adverse effects*; D005260:Female; D006801:Humans; D015918:Infusion Pumps, Implantable / Q000009:adverse effects*; D008279:Magnetic Resonance Imaging; D008580:Meningism / Q000209:etiology*; D013116:Spinal Cord / Q000473:pathology