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A Severe Baclofen Intoxication Mimicking Post-Hypoxic Encephalopathy: Wait and See!
Lieke Muntinga1, Adine J Klijn2, Gerrit Jan Noordergraaf1
1Department of Anesthesiology, Elisabeth-TweeSteden Hospital, Tilburg, Netherlands.
The Journal of Emergency Medicine
|February 1, 2022
Summary
Severe baclofen intoxication can mimic brain death, presenting with coma and absent brainstem reflexes. Prompt supportive care allows for complete neurological recovery without lasting damage.
Area of Science:
- Neurology
- Toxicology
- Emergency Medicine
Background:
- Severe baclofen intoxication is a critical condition that can lead to coma and loss of brainstem reflexes.
- This presentation can mimic brain death, posing a diagnostic challenge in emergency settings.
Observation:
- A patient with spastic cerebral palsy presented with unresponsiveness and absent brainstem reflexes, appearing brain dead.
- An intrathecal baclofen pump and localized swelling were identified, leading to suspicion of baclofen intoxication.
Findings:
- Systemic baclofen intoxication can present as a brain death-like state, with absent brainstem reflexes.
- Serum baclofen levels do not reliably correlate with the severity of central nervous system depression.
- Complete neurological recovery was achieved within 72 hours of intensive supportive care.
Implications:
- Emergency physicians must consider baclofen intoxication in patients with coma and absent brainstem reflexes.
- Recognizing this condition is crucial, as recovery is possible with supportive care, avoiding misdiagnosis of irreversible brain injury.
- Focusing on baclofen intoxication can prevent misattributing symptoms to post-hypoxic encephalopathy, especially after resuscitation.
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