Baclofen overdose mimicking brain death

Area of Science:

• Neurology
• Toxicology
• Critical Care Medicine

Background:

• Brain death guidelines require careful application in drug intoxication cases.
• A common recommendation is to observe patients for five half-lives of a drug after overdose.
• Prolonged coma in overdose patients can complicate the assessment of brain death.

Observation:

• Two cases of severe baclofen intoxication presented with profound coma and absent brainstem reflexes.
• Despite initial concerns for brain death, patients exhibited delayed arousal days after overdose.
• Standard neurological assessments, including EEG and apnea tests, were inconclusive in determining brain death.

Findings:

• Baclofen intoxication can induce prolonged and deep coma, potentially mimicking brain death.
• A fixed 5-half-life observation period is inadequate for baclofen overdose, leading to potential misdiagnosis.
• Delayed neurological recovery was observed in patients with massive baclofen overdose.

Implications:

• Physicians must exercise extreme caution when evaluating brain death in comatose patients with drug intoxication.
• Extended observation periods are necessary to allow for adequate drug clearance and neurological recovery.
• These findings highlight the need for revised protocols for assessing brain death in specific intoxication scenarios, like baclofen overdose.