Department of Neurological Surgery, Northwestern University, Feinberg School of Medicine, Chicago, IL, USA.
Pain Physician. 2013 Mar-Apr;16(2):E113-8.
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.
鞘内注射巴氯芬（ITB）输注已成为治疗严重痉挛的常用方法。这些药物输送系统有许多并发症已经被报道，例如与剂量不当、植入泵或导管的机械故障或术后伤口问题有关。我们报告了一例 ITB 输注停止后发生假性脑脊膜膨出的病例。一名 21 岁男性，因创伤性脑损伤（TBI）导致四肢痉挛性瘫痪，在腹部植入了每天 215 微克的持续 ITB 泵，出现了假性脑脊膜膨出，包裹着 ITB 泵。假性脑脊膜膨出经皮抽吸，大约 15 小时后，患者出现了急性巴氯芬戒断的症状和体征。因此，患者接受了 ITB 输注系统的探查，术中进行了硬膜外血贴。在接下来的 18 小时内，ITB 戒断的症状有所改善。48 小时后，皮下脑脊液（CSF）积聚部分再次出现，但第二次硬膜外血贴后得到解决。该病例说明了 ITB 输注严重并发症的一种独特表现。这强调了及时诊断和治疗急性巴氯芬戒断是获得最佳结果的关键。
