Bilateral, sub-acute subdural hematoma following intra-thecal baclofen pump insertion: case report and literature review
Tóm tắt
Intra-thecal baclofen pump has been proven a safe and effective treatment of spasticity. Subdural hematoma has been rarely described following intra-thecal drug delivery device insertion. We report on the rare case of a 45-year-old male with multiple sclerosis who presented with symptoms of intra-cranial hypotension 1 month after insertion of an intra-thecal baclofen pump for severe spasticity. Non-contrast head computerized tomography scan revealed bilateral, sub-acute, subdural hematomas. Due to the nature of the patient’s symptoms suggesting intra-cranial hypotension, surgical repair of the cerebrospinal fluid leak only was initially performed. However, after an initial improvement, the patient experienced increasing in severity headache and worsening tetraparesis. Subsequently, the patient underwent burr hole evacuation of the subdural hematomas with improvement of his symptoms. On the 6-week follow-up, he reported no headache and he was able to walk with assistance. Subdural hematomas should be considered in all patients presenting with new neurologic deficits or persistent headache following intra-thecal drug delivery device insertion. Early recognition and appropriate management of this rare but potentially life-threatening complication is of great importance to improve prognosis and patient outcomes.
Tài liệu tham khảo
Albright AL, Gilmartin R, Swift D, Krach LE, Ivanhoe CB, McLaughlin JF. Long-term intrathecal baclofen therapy for severe spasticity of cerebral origin. J Neurosurg. 2003;98(2):291–5.
Coffey RJ, Camel D, Park TS, Ordia J, Meyihaler J, Herman R, et al. Intrathecal baclofen for intractable spasticity of spinal origin: results of a long-term multicenter study. J Neurosurg. 1993;78:226–32.
Vender JR, Hester S, Waller JL, Rekito A, Lee MR. Identification and management of intrathecal baclofen pump complications: a comparison of pediatric and adult patients. J Neurosurg. 2006;104(1 Suppl):9–15 Available from: http://www.ncbi.nlm.nih.gov/pubmed/16509474.
Borrini L, Bensmail D, Thiebaut JB, Hugeron C, Rech C, Jourdan C. Occurrence of adverse events in long-term intrathecal baclofen infusion: a 1-year follow-up study of 158 adults. Arch Phys Med Rehabil. 2014;95(6):1032–8.
Lad SP, Li G, Lin SC, Henderson JM. Intracranial hypotension from intrathecal baclofen pump insertion: a case report and review of the literature. Stereotact Funct Neurosurg. 2008;86(2):75–9.
Magro E, Remy-Neris O, Seizeur R, Allano V, Quinio B, Dam-Hieu P. Bilateral subdural hematoma following implantation of intrathecal drug delivery device. Neuromodulation. 2011;14(2):179–82.
Beier AD, Soo TM, Claybrooks R. Subdural hematoma after microdiscectomy: a case report and review of the literature. Spine J. 2009;9(10):e9–12.
Samdani A, Garonzik IM, Zahos P. Subdural hematoma after diagnostic lumbar puncture. Am J Emerg Med. 2004;22(4):316–7.
Kunz U, Panning B, Stolke D. Chronic subdural hematoma following spinal anesthesia [Article in German. Regional-Anaesthesie. 1989;12(2):34–7.
Suess O, Stendel R, Baur S, Schilling A, Brock M. Intracranial haemorrhage following lumbar myelography: case report and review of the literature. Neuroradiology. 2000;42(3):211–4.
Kim SB, Kim MK, Kim KD, Lim YJ. Unintended complication of intracranial subdural hematoma after percutaneous epidural neuroplasty. J Korean Neurosurg Soc. 2014;55(3):170–2.
Velarde CA, Zuniga RE, Leon RF, Abram SE. Cranial nerve palsy and intracranial subdural hematoma following implantation of intrathecal drug delivery device. Reg Anesth Pain Med. 2000;25(1):76–8.
Srinivasan SK, Patil AA. Axial (central) downward herniation of the brain as a complication of intra-thecal drug delivery system (IDDS) implant-a case report. Clin Neurol Neurosurg. 2014;125:78–80.