Department of Neurological Surgery, Rutgers New Jersey Medical School, Newark New Jersey, USA.
Department of Neurological Surgery, Rutgers New Jersey Medical School, Newark New Jersey, USA.
World Neurosurg. 2020 Apr;136:136-139. doi: 10.1016/j.wneu.2020.01.044. Epub 2020 Jan 16.
Encephalopathy is reported to have affected 250,000 people in the United States over the last decade, with considerable morbidity and mortality. Baclofen, a gamma-aminobutyric acid-B agonist that acts on the central nervous system, is the drug most widely used to treat spasticity. Baclofen overdose is a potentially deadly condition that can cause encephalopathy and can result from multiple etiologies. Renal disease can contribute to baclofen overdose and encephalopathy, and there are currently no dosing recommendations for patient's on baclofen with renal impairment.
We report an unusual case of a man aged 35 years who presented with persistent fevers, seizures, and normal mentation. The patient presented with intrathecal baclofen use and prior exposure to West Nile Virus. He developed acute kidney injury at hospital secondary to vancomycin use, and mental status declined.
This case highlights that patients with baclofen overdose can initially appear to have serious brain injury, however, full patient recovery can occur in <72 hours. This case provides additional insight into the guidelines for the treatment and management for unknown cause encephalopathy. This case also highlights the link between renal disease, baclofen, and encephalopathy through a review of the literature.
据报道，在过去十年中，美国有 25 万人患有脑病，发病率和死亡率都相当高。巴氯芬是一种作用于中枢神经系统的γ-氨基丁酸-B 激动剂，是最广泛用于治疗痉挛的药物。巴氯芬过量是一种潜在的致命疾病，可导致脑病，并可由多种病因引起。肾脏疾病可导致巴氯芬过量和脑病，目前对于肾功能损害的巴氯芬患者尚无剂量推荐。
我们报告了一例罕见的 35 岁男性病例，其表现为持续发热、癫痫发作和正常的精神状态。该患者因使用鞘内巴氯芬和先前接触西尼罗河病毒而出现脑病。由于万古霉素的使用，他在医院继发急性肾损伤，精神状态下降。
本例强调了巴氯芬过量的患者最初可能表现出严重的脑损伤，但在<72 小时内可完全恢复。本病例为不明原因脑病的治疗和管理指南提供了更多的见解。通过文献复习，本病例还强调了肾脏疾病、巴氯芬和脑病之间的联系。
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