From the Department of Neurology.
Department of Neurosurgery, University of California, Irvine.
Pediatr Emerg Care. 2021 Mar 1;37(3):e141-e146. doi: 10.1097/PEC.0000000000002361.
Baclofen is commonly used in both pediatric and adult patients to treat spasticity secondary to spinal cord and cerebral pathology. A broad range of symptoms and severity of baclofen toxicity have been described. However, to our knowledge, there are no reports to date of baclofen toxicity mimicking brain death in pediatric patients.
We reviewed the presentation, clinical course, diagnostic studies including imaging and electroencephalography, and outcome of a patient with transient coma and loss of brainstem reflexes mimicking brain death secondary to baclofen toxicity.
During a baclofen pump refill, a 12-year-old boy with cerebral palsy had inadvertent injection of 12,000 μg of baclofen into the pocket around his pump. Within an hour, he presented with acute altered mental status that rapidly progressed to a comatose state with absent brainstem reflexes.
After appropriate management, the patient returned to his neurological baseline by hospital day 3.
We reviewed the literature for varying presentations of baclofen toxicity and associated electroencephalography findings, mechanism of overdose, and different management options. In this case, the mechanism of baclofen toxicity was suspected to be secondary to extravasation from the pump pocket and subsequent systemic absorption.
Patients with baclofen toxicity may have a dramatic presentation and an initial examination mimicking brain death. Given its rarity, this clinical entity may not be readily recognized, and there is potential for misinterpretation of diagnosis and prognosis. It is important for physicians to be familiar with this clinical scenario to avoid false declaration of brain death.
巴氯芬常用于治疗脊髓和脑病理引起的痉挛，在儿科和成人患者中均有应用。巴氯芬中毒的症状和严重程度范围广泛。然而，据我们所知，目前尚无关于儿科患者巴氯芬中毒模拟脑死亡的报告。
我们回顾了一位因巴氯芬中毒导致短暂昏迷和脑干反射丧失、模拟脑死亡的患儿的临床表现、临床病程、包括影像学和脑电图在内的诊断性研究及结果。
在一次巴氯芬输注泵补液时，一名患有脑瘫的 12 岁男孩意外将 12000μg 巴氯芬注入其输注泵周围的口袋中。在 1 小时内，他出现急性意识改变，迅速进展为昏迷状态，且脑干反射消失。
经过适当的治疗，患者在入院第 3 天恢复到神经基线状态。
我们回顾了文献中关于巴氯芬中毒的不同表现和相关脑电图发现、药物过量的机制以及不同的治疗选择。在本例中，巴氯芬中毒的机制被怀疑是由于从泵袋外渗和随后的全身吸收引起的。
巴氯芬中毒的患者可能表现出戏剧性的症状，且初始检查可能模拟脑死亡。由于其罕见性，这种临床情况可能不容易被识别，并且存在诊断和预后的潜在误解。医生熟悉这种临床情况非常重要，以避免错误地宣布脑死亡。
