title: Migrating lumbar intrathecal catheter fragment associated with intracranial subarachnoid hemorrhage.
abstract: Intrathecal catheter placement into the lumbar cistern has varied indications, including drug delivery and CSF diversion. These Silastic catheters are elastic and durable; however, catheter-associated malfunctions are well reported in the literature. Fractured catheters are managed with some variability, but entirely intradural retained fragments are often managed conservatively with observation. The authors describe a case of a 70-year-old man with an implanted intrathecal morphine pump for failed back surgery syndrome who presented to an outside hospital with a history of headache, neck pain, nausea, and photophobia of 3 days' duration. He also described mild weakness and intermittent numbness of both legs. Unenhanced head CT demonstrated subarachnoid hemorrhage (SAH). A right C-5 hemilaminectomy was performed. This case is unique in that there was no indication that the lumbar intrathecal catheter had fractured prior to the patient's presentation with SAH. This case demonstrates that intrathecal catheter fragments are mobile and can precipitate intracranial morbidity. Extrication of known fragments is safe and should be attempted to prevent further neurosurgical morbidity.
authors.affiliation: Department of Neurological Surgery, Oregon Health & Science University, Portland, Oregon.
authors.forename: Luke
authors.initials: L
authors.lastname: Hnenny
authors.forename: Hatem A
authors.initials: HA
authors.lastname: Sabry
authors.forename: Jeffrey S
authors.initials: JS
authors.lastname: Raskin
authors.forename: Jesse J
authors.initials: JJ
authors.lastname: Liu
authors.forename: Neil E
authors.initials: NE
authors.lastname: Roundy
authors.forename: Aclan
authors.initials: A
authors.lastname: Dogan
mesh_terms: D000368:Aged; D000701:Analgesics, Opioid / Q000008:administration & dosage; D057785:Catheters / Q000009:adverse effects; D055111:Failed Back Surgery Syndrome / Q000188:drug therapy*; D005539:Foramen Magnum / Q000000981:diagnostic imaging; D005548:Foreign-Body Migration / Q000000981:diagnostic imaging* / Q000209:etiology*; D006801:Humans; D015918:Infusion Pumps, Implantable / Q000009:adverse effects*; D007278:Injections, Spinal; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging; D008297:Male; D009020:Morphine / Q000008:administration & dosage*; D013345:Subarachnoid Hemorrhage / Q000000981:diagnostic imaging / Q000209:etiology*; D014057:Tomography, X-Ray Computed; D014715:Vertebrobasilar Insufficiency / Q000000981:diagnostic imaging / Q000209:etiology
chemical_list: D000701:Analgesics, Opioid; D009020:Morphine
keywords: SAH = subarachnoid hemorrhage; intracranial morbidity; intrathecal morphine pump; lumbar spine; subarachnoid hemorrhage; vascular disorders