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Microfracture of a baclofen pump catheter with intermittent under- and overdose

William J Dawes1, James M Drake, Darcy Fehlings

  • 1Department of Neurosurgery, Hospital for Sick Children, and Bloorview-MacMillan Rehabilitation Center, Toronto, Canada.

Pediatric Neurosurgery
|July 24, 2003
PubMed

Insights

A microfracture in an intrathecal baclofen pump catheter caused confusing symptoms of under- and overdose. This rare catheter defect requires advanced imaging for diagnosis, impacting baclofen pump therapy.

Area of Science:

  • Neurology
  • Biomedical Engineering
  • Medical Device Technology

Background:

  • Intrathecal baclofen pump (IBP) therapy is crucial for managing spasticity.
  • Catheter integrity is vital for effective and safe drug delivery.
  • Complications can arise from implanted medical devices, necessitating thorough investigation.

Observation:

  • An 8-year-old boy with an IBP experienced fluctuating symptoms suggestive of both baclofen under- and overdose.
  • Standard diagnostic methods including pump interrogation, imaging (X-ray, CT), and fluoroscopy did not reveal the cause.
  • A subtle extradural catheter microfracture was identified only upon high-magnification examination and scanning electron microscopy.

Findings:

  • A previously undetected microfracture in the extradural portion of the intrathecal catheter was the source of the patient's symptoms.
  • The microfracture led to unpredictable drug delivery, mimicking under- and overdose scenarios.
  • Symptomatic resolution occurred after the catheter was surgically replaced.

Implications:

  • Catheter microfractures in IBP systems can present diagnostic challenges.
  • Advanced imaging techniques may be necessary to identify subtle catheter defects.
  • This case highlights the importance of considering rare mechanical failures in IBP complications.

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