Subdural catheter migration may lead to baclofen pump dysfunction.

OBJECTIVES

To report an unusual cause of intrathecal drug delivery failure in baclofen pump device.

STUDY DESIGN

A case report of an SCI patient treated with intrathecal baclofen, presenting a drug withdrawal.

SETTING

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.