title: Emergent intrathecal baclofen withdrawal after pseudomeningocele aspiration.
abstract: Intrathecal baclofen (ITB) infusion has become a common treatment for severe spasticity. Many complications of these drug delivery systems have been reported such as those related to improper dosing, mechanical failure of the implanted pump or catheter, or post-operative wound issues. We report a case of ITB withdrawal after pseudomeningocele aspiration. 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 and approximately 15 hours later the patient developed signs and symptoms of acute baclofen withdrawal. As a result, the patient underwent an exploration of the ITB infusion system with an intraoperative epidural blood patch. The symptoms of ITB withdrawal improved over the next 18 hours. The subcutaneous cerebrospinal fluid (CSF) collection partially recurred 48 hours later, but this resolved after a second epidural blood patch. The case illustrates a unique presentation of a serious complication of ITB infusion. This underscores that timely diagnosis and treatment of acute baclofen withdrawal is key to optimal outcomes.
authors.affiliation: Department of Neurological Surgery, Northwestern University, Feinberg School of Medicine, Chicago, IL, USA. timothy-smith-o@fsm.northwestern.edu
authors.forename: Timothy R
authors.initials: TR
authors.lastname: Smith
authors.forename: Divakar S
authors.initials: DS
authors.lastname: Mithal
authors.forename: Anne
authors.initials: A
authors.lastname: Park
authors.forename: Angela
authors.initials: A
authors.lastname: Bohnen
authors.forename: Joseph
authors.initials: J
authors.lastname: Adel
authors.forename: Joshua M
authors.initials: JM
authors.lastname: Rosenow
mesh_terms: D001418:Baclofen / Q000008:administration & dosage*; D006801:Humans; D015918:Infusion Pumps, Implantable / Q000009:adverse effects*; D008297:Male; D008588:Meningocele / Q000209:etiology* / Q000601:surgery; D009125:Muscle Relaxants, Central / Q000008:administration & dosage*; D013375:Substance Withdrawal Syndrome / Q000209:etiology*; D013396:Suction; D055815:Young Adult
chemical_list: D009125:Muscle Relaxants, Central; D001418:Baclofen