Injected contrast study fails to demonstrate catheter-pump connector tear

Area of Science:

• Pediatric Neurology
• Neurosurgery
• Rehabilitation Medicine

Background:

• Intrathecal baclofen (ITB) therapy is crucial for managing severe spasticity in conditions like cerebral palsy (CP).
• Patients on ITB therapy may experience increased tone, necessitating investigation into potential complications.
• Device-related issues, such as catheter or pump malfunction, are common causes of treatment failure.

Purpose of the Study:

• To present a case of a pediatric patient with CP experiencing increased tone due to a malfunctioning ITB system.
• To highlight the diagnostic process and successful management of a rare ITB pump-catheter connector tear.

Main Methods:

• A 11-year-old boy with CP, shunted hydrocephalus, and ITB therapy for hypertonicity presented with worsening tone.
• Diagnostic evaluation included clinical assessment, review of imaging (X-rays), and response to a test bolus of ITB.
• Surgical exploration was performed to identify and repair the suspected device failure.

Main Results:

• X-ray findings suggested a tear in the pump-catheter connector sleeve.
• A test bolus of ITB provided temporary symptom relief.
• Surgery confirmed a torn pump-catheter connector, which was replaced, resolving the patient's symptoms and allowing for optimized ITB dosage.

Conclusions:

• Increased ITB dosage requirements in patients with CP often indicate a catheter or pump-related problem.
• Palpable fluid in the pump pocket is a significant indicator of a potential catheter/pump connector tear.
• Accurate diagnosis can be achieved through careful clinical evaluation, radiographic review, and assessment of treatment response.