Leiphart James W, Leiphart Thaddeus J
Neurosurgery, University of Virginia School of Medicine, Falls Church, USA.
Neurosurgery, Inova Health System, Falls Church, USA.
Cureus. 2024 Oct 2;16(10):e70720. doi: 10.7759/cureus.70720. eCollection 2024 Oct.
Intrathecal morphine is associated with the complication of catheter tip granuloma which causes symptoms of decreased pain control, increased required dose, and neurological deficit. Catheter tip granulomas from intrathecal baclofen are thought to never occur because of the mechanism by which intrathecal morphine causes granulomas. We present a case of an intrathecal baclofen induced scarring of a catheter tip with clinical characteristics similar to some symptoms of granuloma. A 66-year-old woman with multiple sclerosis induced spasticity was partially controlled with intrathecal baclofen delivery at an extremely high dose of 1638 micrograms per day. She presented in the hospital with symptoms of withdrawal from intrathecal baclofen and required an emergency revision of her baclofen pump. Replacement of the catheter demonstrated complete occlusion of the catheter tip by scar tissue. Following surgery, her spasticity was well-controlled at the much lower dose of 200 micrograms per day. Intrathecal baclofen delivery can cause catheter tip scarring which causes some symptoms similar to catheter tip granuloma. Early recognition of these signs of catheter tip occlusion could help prevent progression to withdrawal.
鞘内注射吗啡与导管尖端肉芽肿并发症相关，该并发症会导致疼痛控制效果下降、所需剂量增加以及神经功能缺损等症状。鞘内注射巴氯芬所致的导管尖端肉芽肿被认为不会发生，因为鞘内注射吗啡导致肉芽肿形成的机制不适用于鞘内注射巴氯芬。我们报告一例鞘内注射巴氯芬导致导管尖端瘢痕形成的病例，其临床特征与肉芽肿的一些症状相似。一名患有多发性硬化症所致痉挛的66岁女性，通过鞘内注射巴氯芬以每天1638微克的极高剂量进行部分控制。她因鞘内注射巴氯芬戒断症状入院，需要紧急更换巴氯芬泵。更换导管时发现导管尖端被瘢痕组织完全阻塞。手术后，她的痉挛在每天200微克的较低剂量下得到了良好控制。鞘内注射巴氯芬可导致导管尖端瘢痕形成，进而引发一些与导管尖端肉芽肿相似的症状。早期识别这些导管尖端阻塞的迹象有助于预防病情发展至戒断状态。
