Disclosures: Kiin Kim, MD: Nothing to disclose

Case Description: A pediatric patient with a history of midbrain pilocytic astrocytoma status post radical subtotal resection complicated by bilateral thalamic stroke presented with self-mutilating behaviors involving biting of the lower lip, tongue and fingers. Anti-spastic management including high-dose baclofen, tizanidine, and Botox injections was trialed without success. After an unrevealing extensive workup, his self-mutilating behaviors were attributed to central pain syndrome in addition to spasticity. As a result, an intrathecal baclofen pump was implanted with a catheter advanced into the retroclival area, and the patient consequently had a significant improvement in his symptoms.

Setting: Inpatient medical unit of a pediatric hospital

Patient: A 6-year-old African American male

Assessment/Results: The patient had a significant relief in his pain and spasticity as well as his self-aggressive behaviors. His follow up physical exam showed spasticity in all extremities improved from 3 to 1 on the MAS scale as well as increased range of motion.

Discussion: Central pain syndrome (CPS) describes a mixture of sensory abnormalities prominently characterized by neuropathic pain resulting from a dysfunction or damage in the central nervous system. The patient in our case developed CPS following a brain tumor resection and bilateral thalamic stroke. The resultant CNS lesion with thalamic dysfunction caused intractable pain and spasticity, which in turn caused self-mutilating behaviors refractory to multiple treatments including neuropathic agents, antispasmodics, and Botox injection. As a result, an intrathecal baclofen pump was implanted with a catheter in the posterior fossa, and the patient’s symptoms significantly improved.

Conclusion: This case demonstrates a unique management of central pain syndrome and spasticity leading to self-mutilating behaviors in a pediatric patient with a non-traumatic brain injury and stroke. We highlight in this case the challenging yet successful placement of a baclofen pump catheter into the prepontine region to adequately manage the patient’s symptoms.

Level of Evidence: Level IV

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/management-of-central-pain-syndrome-with-an-intrathecal-baclofen-pump-after-brainstem-tumor-resection-and-bilateral-thalamic-stroke-a-case-report/