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Scar Tissue Catheter Tip Occlusion From an Intrathecal Baclofen Delivery: A Case Report and Review of the Literature
James W Leiphart1,2, Thaddeus J Leiphart2
1Neurosurgery, University of Virginia School of Medicine, Falls Church, USA.
Abstract:
Intrathecal morphine is associated with the complication of catheter tip granuloma which causes symptoms of decreased pain control, increased required dose, and neurological deficit. Catheter tip granulomas from intrathecal baclofen are thought to never occur because of the mechanism by which intrathecal morphine causes granulomas. We present a case of an intrathecal baclofen induced scarring of a catheter tip with clinical characteristics similar to some symptoms of granuloma. A 66-year-old woman with multiple sclerosis induced spasticity was partially controlled with intrathecal baclofen delivery at an extremely high dose of 1638 micrograms per day. She presented in the hospital with symptoms of withdrawal from intrathecal baclofen and required an emergency revision of her baclofen pump. Replacement of the catheter demonstrated complete occlusion of the catheter tip by scar tissue. Following surgery, her spasticity was well-controlled at the much lower dose of 200 micrograms per day. Intrathecal baclofen delivery can cause catheter tip scarring which causes some symptoms similar to catheter tip granuloma. Early recognition of these signs of catheter tip occlusion could help prevent progression to withdrawal.
Insights
Intrathecal baclofen may cause catheter tip scarring, mimicking granuloma symptoms and leading to withdrawal. Early detection of catheter occlusion is crucial for effective spasticity management.
Area of Science:
- Neurology
- Neurosurgery
- Pharmacology
Background:
- Intrathecal morphine is known to cause catheter tip granulomas, leading to decreased efficacy and neurological deficits.
- Catheter tip granulomas are believed to be rare with intrathecal baclofen due to differing mechanisms of action.
Observation:
- A patient with severe spasticity on high-dose intrathecal baclofen presented with withdrawal symptoms.
- Emergency pump revision revealed complete catheter tip occlusion due to scar tissue formation.
Findings:
- Intrathecal baclofen delivery can induce catheter tip scarring, presenting clinically similar to granuloma.
- Successful revision and reduced baclofen dosage controlled spasticity, indicating catheter occlusion was the cause.
Implications:
- This case highlights that intrathecal baclofen can cause catheter tip occlusion, contrary to previous assumptions.
- Early identification of catheter tip occlusion signs is vital to prevent severe withdrawal and manage spasticity effectively.
