%0 Journal Article %1 Lew2005 %A Lew, Sean M %A Psaty, Estee L %A Abbott, Rick %D 2005 %J Neurosurgery %K Adolescent; Baclofen; Cerebral Palsy; Consciousness Disorders; Contrast Media; Dystonic Equipment Failure; Female; Humans; Hypotension; Hypoventilation; Infusion Pumps, Implantable; Injections, Spinal; Iohexol; Muscle Hypotonia; Spasticity; Overdose; Parasympatholytics; Respiration, Artificial; Subdural Space %N 3 %P E624; discussion E624 %T An unusual cause of overdose after baclofen pump implantation: case report. %V 56 %X OBJECTIVE AND IMPORTANCE: Intrathecal baclofen delivery for the treatment of spasticity has been used for almost 20 years with a great deal of success. A wide variety of complications and pitfalls have been described. This report details a novel complication involving inadvertent and initially unrecognized canalization of the subdural space with the spinal catheter, which ultimately resulted in an overdose. CLINICAL PRESENTATION: An intrathecal pump system was implanted in a 15-year-old girl with spasticity. This initially resulted in a lack of therapeutic effect. The diagnostic workup ultimately led to contrast administration through the pump system, which precipitated a baclofen overdose when sequestered medication in the subdural compartment was released into the intrathecal space. INTERVENTION: The spinal catheter was subsequently revised, and the patient made a full recovery. CONCLUSION: The possibility of a subdural catheter should be included in the differential diagnosis in patients who experience a lack of drug effect after pump implantation, despite increases in dosage. Close monitoring is required because of the risk of spontaneous or induced overdose, which may occur when a communication develops between the subdural and intrathecal compartments.

@article{Lew2005, abstract = {OBJECTIVE AND IMPORTANCE: Intrathecal baclofen delivery for the treatment of spasticity has been used for almost 20 years with a great deal of success. A wide variety of complications and pitfalls have been described. This report details a novel complication involving inadvertent and initially unrecognized canalization of the subdural space with the spinal catheter, which ultimately resulted in an overdose. CLINICAL PRESENTATION: An intrathecal pump system was implanted in a 15-year-old girl with spasticity. This initially resulted in a lack of therapeutic effect. The diagnostic workup ultimately led to contrast administration through the pump system, which precipitated a baclofen overdose when sequestered medication in the subdural compartment was released into the intrathecal space. INTERVENTION: The spinal catheter was subsequently revised, and the patient made a full recovery. CONCLUSION: The possibility of a subdural catheter should be included in the differential diagnosis in patients who experience a lack of drug effect after pump implantation, despite increases in dosage. Close monitoring is required because of the risk of spontaneous or induced overdose, which may occur when a communication develops between the subdural and intrathecal compartments.}, added-at = {2014-07-19T20:42:22.000+0200}, author = {Lew, Sean M and Psaty, Estee L and Abbott, Rick}, biburl = {https://www.bibsonomy.org/bibtex/2b3a11b81ae769239ba8fae6166dae82e/ar0berts}, groups = {public}, interhash = {c12ee0b59122d210b0039b74b4a1a4c5}, intrahash = {b3a11b81ae769239ba8fae6166dae82e}, journal = {Neurosurgery}, keywords = {Adolescent; Baclofen; Cerebral Palsy; Consciousness Disorders; Contrast Media; Dystonic Equipment Failure; Female; Humans; Hypotension; Hypoventilation; Infusion Pumps, Implantable; Injections, Spinal; Iohexol; Muscle Hypotonia; Spasticity; Overdose; Parasympatholytics; Respiration, Artificial; Subdural Space}, month = Mar, number = 3, pages = {E624; discussion E624}, pmid = {15730591}, timestamp = {2014-07-19T20:42:22.000+0200}, title = {An unusual cause of overdose after baclofen pump implantation: case report.}, username = {ar0berts}, volume = 56, year = 2005 }