Objectives: To report an unusual cause of intrathecal drug delivery failure in baclofen pump device. Study design: A case report of an SCI patient treated with intrathecal baclofen, presenting a drug withdrawal. Setting: Regional spinal cord injuries centre in Geneva (Switzerland). Methods: We present a case of a 38-year-old male with complete T9 spastic paraplegia for 15 years, treated with intrathecal baclofen for 11 years. He recently presented to our centre with a spastic hypertonic episode, associated with rhabdomyolysis. Results: Standard investigations were unrevealing. However, a CT scan performed after injecting a radio-opaque solution by the side port of the pump, showed an unexpected catheter migration into the subdural space. Surgical revision reversed withdrawal symptoms. Conclusions: Subdural catheter migration must be considered in the differential diagnosis of intrathecal drug delivery system failures. We recommend the use of the CT scan after contrast injection, to detect the localization of the distal catheter tip and confirm the normal diffusion into the subarachnoid space.
Study design: Case report of a 31-year-old woman who presented with toxic myelopathy due to intrathecal administration of doxorubicin. Objective: To describe the pathology and the rehabilitation of an uncommon complication of intrathecal drug administration during the oncologic treatment of acute lymphoma. Setting: Spinal cord rehabilitation center, University Hospital. Method: Clinical and radiological observations during a rehabilitation program. Results: Evidence of neurological improvement and rehabilitation potential after severe myelopathy due to intrathecal injection of doxorubicin. Conclusion: This is, to our knowledge, the first report of severe myelopathy following accidental intrathecal administration of doxorubicin. Despite early complete paraplegia, some neurological and functional recovery was observed.
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