Disclosures: Barent Bradt, DO: No financial relationships or conflicts of interest

Case Diagnosis: Intrathecal Baclofen Pump Catheter Tubing Crack

Case Description or Program Description: Patient is a 31-year-old female with medical history of mixed spastic/dystonic tetraplegia cerebral palsy with an intrathecal baclofen pump. She presented to the hospital with a 1-week history of irritability, fevers, increased spasticity and swelling over the pump site, increased work of breathing, and breakthrough seizures. Two days prior she had her pump refilled, to her stable dose of greater than two years – 1598.3 mcg/day. Increased spasticity with sustained clonus of feet and modified Ashworth Scale(MAS) 2 in bilateral hamstrings was controlled with oral diazepam.

Setting: Children’s Hospital of Michigan

Assessment/Results: Work-up revealed pneumonia with respiratory failure requiring intubation and sedation. Imaging also revealed a large fluid collection over the baclofen pump that was aspirated and found to be CSF.

She was taken to the OR due to notable fracture of the tubing at its connection point to the baclofen pump. The tubing was replaced and her intrathecal baclofen dose was reduced to 1101 mcg/day, and further decreased to 500 mcg. During evaluation at this dose her spasticity was noted to be well controlled. By discharge she was found to have increased tone in her ankles and her intrathecal baclofen dose was increased to 550 mcg/day. Five days after discharge she was seen in clinic and her pump was increased to 600 mcg/day. Four weeks after discharge her intrathecal baclofen dose was further increased to 660 mcg/day and she received Onabotulinum toxin A injections to hamstrings, with drastic improvement in lower extremity tone with non sustained clonus of foot and decreased burden to caregiver.

Discussion (relevance): The case patient had a stable dose of intrathecal baclofen over two years but with signs and symptoms of withdrawal, evaluation revealed a crack in her intrathecal tubing with CSF accumulation. This finding may explain her controlled spasticity at lower dose after tubing was replaced.

Conclusions: Intrathecal baclofen pump complications can arise from issues with the motor of the pump, attachment of the pump catheter, catheter kink, or catheter tip. This case patient did not have a catheter kink but rather a crack that resulted in higher doses of intrathecal baclofen dosage before the patient had symptoms.

Level of Evidence: Level IV

« Back to AAPM&R Annual Assembly 2022

PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/an-unusual-presentation-of-acute-baclofen-withdrawal-with-findings-of-intrathecal-baclofen-pump-catheter-tubing-deformity-a-case-report/