Spasticity is a complex problem in patients with neurological disorders and may distress their quality of life. Intrathecal baclofen infusion pumps reduce spasticity with low doses and minimal side ...effects but are not free from complications. We aimed to evaluate the efficacy and safety of intrathecal baclofen infusion pumps as well as patients' satisfaction.
Retrospective cohort study including all intrathecal baclofen infusion pumps placed up to December 2015. Demographic characteristics, clinical diagnoses, date of placement or withdrawal/replacement of intrathecal baclofen infusion pumps, baclofen dosage and complications of intrathecal baclofen infusion pumps were collected. Assessments from the Ashworth and Penn's scales, Katz index and patients' global satisfaction were analysed.
In 19 years we placed 251 intrathecal baclofen infusion pumps in 155 patients. The mean age was 41.1 ± 15.8 years. The most frequent conditions were: trauma (34%), cerebral palsy (14%), multiple sclerosis (12%) and stroke (12%). Eighty-five patients (55%) required a second pump, and eleven (7%) a third one. The lifetime of the first pump was 72 (36 - 89) and the total follow-up time was 96 (9 - 132) months. The causes of withdrawal/replacement were: battery failure (57%), catheter migration/kinking (24%), infection (14%) and pump displacement/exteriorization (7%). The complication rate was 0.21 events/month. There was a significant improvement in the Ashworth and Penn's scales after the placemen of intrathecal baclofen infusion pumps (p < 0.001 for all diagnoses) and the patients were satisfied with the treatment.
The incidence of complications was within range of other international studies despite our long follow-up time. Events per month, loss to follow-up, re-intervention rate, incidence of infection and mortality were similar to other studies.
Intrathecal baclofen infusion pumps are safe and effective in the treatment of spasticity. Infusion pumps provide a high level of satisfaction regarding treatment and quality of life.
Spontaneous splenic rupture (SSR) is a rare and potentially life-threatening condition often associated with trauma. However, SSR can occur without evident trauma, presenting unique diagnostic ...challenges. We present a case report of a 32-year-old postpartum female who experienced sudden-onset abdominal pain and was diagnosed with SSR. Despite the absence of trauma, she exhibited hypovolemic shock, requiring rapid intervention. Diagnostic imaging, including CT scans, revealed a substantial splenic laceration, which led to an emergent splenectomy. The patient’s postoperative course was complicated by infective endocarditis (IE) with aortic involvement, elucidated as the underlying cause of SSR. The patient underwent aortic valve replacement, received antibiotic therapy, and achieved a successful recovery. This case underscores the importance of early recognition, timely intervention, and collaboration among diverse medical specialties in managing SSR cases. Furthermore, it highlights the potential link between SSR and IE, emphasizing the meaning of considering infectious etiologies even in non-traumatic scenarios. Early identification of the underlying cause is crucial for effective management and positive patient outcomes in cases of SSR.
Spontaneous splenic rupture (SSR) is a rare and potentially life-threatening condition often associated with trauma. However, SSR can occur without evident trauma, presenting unique diagnostic ...challenges. We present a case report of a 32-year-old postpartum female who experienced sudden-onset abdominal pain and was diagnosed with SSR. Despite the absence of trauma, she exhibited hypovolemic shock, requiring rapid intervention. Diagnostic imaging, including CT scans, revealed a substantial splenic laceration, which led to an emergent splenectomy. The patient's postoperative course was complicated by infective endocarditis (IE) with aortic involvement, elucidated as the underlying cause of SSR. The patient underwent aortic valve replacement, received antibiotic therapy, and achieved a successful recovery. This case underscores the importance of early recognition, timely intervention, and collaboration among diverse medical specialties in managing SSR cases. Furthermore, it highlights the potential link between SSR and IE, emphasizing the meaning of considering infectious etiologies even in non-traumatic scenarios. Early identification of the underlying cause is crucial for effective management and positive patient outcomes in cases of SSR.
COMPLICATIONS ASSOCIATED WITH INTRATHECAL CONTINUOUS INFUSION BACLOFEN PUMPS FOR SPASTICITY TREATMENT - 14 YEARS OF EXPERIENCEBackground and goal of study:Intrathecal implantation of continuous ...infusion baclofen pumps (CIBP) for spasticity treatment is not free from complications. 1,2,3 These may be related to surgery (infection, dehiscence of the suture), human errors (over or under-dose by programming errors), pump-related (battery failure, migration or rotation within the pocket) or catheter-related (disconnection, kinking, fracture and catheter tip granuloma). Complications can lead in rare cases to death (for severe infection or baclofen withdrawal syndrome).2,3 Our study describes complications in patients with CIBP for spasticity treatment.Material and Methods:After study approval by the institutional ethics committee, a retrospective observational study was conducted in patients under treatment in our Chronic Pain Unit, with CIBP. Only patients with complete records were included. 75 patients were evaluated. Collected data were submitted to a descriptive analysis of the variables.Result and Discussion:Average years of follow-up was 7.2 (range 0.9 to 13.4 years). 104 CIBP (average 7.4 pumps / year) were placed. Mean time free from complications was 7.9 years. 56% (n = 42) patients had no complications. Battery failure (end of life) occurred in 66.7% (n = 22) patients, intrinsic pump failure in 12% (n = 9) and implant infection in 2.6% (n = 2). Pump replacement took place in 38.7% (n = 29) of patients. Of these, 75.9% (n = 22) had battery failure. Among patients with complications, only 15.2% (n = 5) had a second complication. No differences were found related to sex, age or spasticity cause.Conclusion:All registered complications were related to technical failure of the pump, except two patients who presented implant infection. There were no human errors. The most frequent complication was battery failure in 66.7% of cases, also responsible for the largest number of replacements of CIBP (75.9%). There are no records of deaths or events associated with side effects to baclofen.References:1N Engl J Med 1989;320:1517-21; 2Neurochirurgie 2003;49:276-88; 3J Intellect Dev Disabil 2011;36:207-13.
FUNCTIONAL OUTCOME OF CONTINUOUS INTRATHECAL BACLOFEN PUMP INFUSION IN SPASTICITYBackground and goal of study:Spasticity is one of the most frequent and incapacitating motor abnormalities present in ...many patients with neurological disorders. Spasticity assessment requires several scales that allow the identification of its intensity and its influence on functional performance.1,2 Baclofen is used to treat spasticity. When administered intrathecally u2013continuous intrathecal baclofen pump infusion (CIBPI) - allows a significant reduction of spasticity, with lower doses of the drug minimizing side effects of oral therapy.3 This study aims to assess functional consequences of CIBPI in the treatment of spasticity.Material and Methods:After approval by the Ethics Committee an observational retrospective study in patients under treatment in our Chronic Pain Unit with CIBPI took place. Patients with complete records regarding functional assessment of spasticity before and after CIBPI were included. 75 patients were included. Functional assessment of spasticity was performed by the functional scales Ashworth and Penn. Collected data were submitted to a descriptive analysis of the variables and non-parametric tests were performed (Wilcoxon) for comparisons.Result and Discussion:From 75 patients analyzed, 62.7% (n = 47) were male and the average age was 45.9 years (range 15 to 75 years). The most common cause of spasticity was stroke (18.8%, n = 14). Scores obtained for both scales were lower after placing the pump (p <0.001 both). Patients with stroke, also presented lower scores in both scales after pump placement (p = 0.001 for the Ashworth scale and p = 0.003 for Penn).Conclusion:In this study we conclude that the CIBPI has a positive impact in the treatment of spasticity with reduced frequency of muscle spasms and rigidity.References:1 Phys Med Rehabil Clin N Am 2001; 12:733-746. 2 Rev. Neurol 2005; 40:30-33. 3 Sinapse 2003; 2:34-39.
Title:Posterior Reversible Encephalopathy Syndrome (PRES) in the Postpartum After Postdural Puncture Headache.Background:Posterior Reversible Encephalopathy Syndrome (PRES) is rare and characterized ...by insidious onset of headache, altered mental status, seizures and cortical blindness with posterior leukoencephalopathy on imaging studies.1 Incidence and pathophysiological mechanism are unknown. It has been associated with hypertensive encephalopathy, immunosuppression and postpartum eclampsia2. We describe a case of PRES associated with postdural puncture headache (PDPH).Case Report:25YO female, ASA1. PDPH following epidural analgesia for labour. Headache improved after 4 days of conservative treatment. Hospital discharge. 2 days after, readmission: generalized tonic-clonic seizure, bilateral amaurosis and headache (no longer postural). Acute Pain Unit activated. Cerebral computed tomography scan(CT): bilateral occipital hypodensities; Venous-CT excluded thrombosis. Brain magnetic resonance(MR) imaging: hyperintense areas on T2/FLAIR within the bilateral parietooccipital lobes with vasogenic edema; patchy left parietal area with cytotoxic oedema. MR angiography: arterial vasospasm, especially at posterior circulation, and subdural effusions. Treatment: Dorsal decubitus at 0u00ba, hydration, paracetamol, nonsteroidal anti-inflammatory drug, caffeine and nimodipine. She remained hemodynamically stable; clinical and imaging improvement. After complete recovering from blindness she was discharged. She remained asymptomatic at six month and one year evaluation.Discussion:In this case clinical symptoms and neuroimaging findings are compatible with PRES.The exact PRES mechanism remains unknown. The temporal association of encephalopathy with diffuse cerebral vasospasm after an episode of PDPH may be causative.Prompt recognition and treatment are crucial to avoid the permanent damage leading to sequelae and mortality.References:1-tT Hammad et al. Posterior Reversible Encephalopathy Syndrome Secondary to CSF Leak and Intracranial Hypotension: A Case Report and Literature Review. Case Reports in Neurological Medicine 2015; 2-tH Chiu-Ming, C Kwok-Hon.Posterior Reversible Encephalopathy Syndrome with Vasospasm in a Postpartum Woman After Postdural Puncture Headache Following Spinal Anesthesia. AnesthAnalg 2007; 105:770-2.Learning points: PRES is a possible complication of postdural puncture. It must be early diagnosed and properly treated.
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