Death after acute withdrawal of intrathecal baclofen: case report and literature review

A 21-year-old man with C1 sensory-incomplete ventilator-dependent quadriplegia, treated with good results with an intrathecal baclofen pump for intractable spasticity since age 17, developed increasing spasticity and revers when his pump began to malfunction. He became unresponsive and developed hypotension, severe hyperthermia, and ventricular tachycardia that required chemical and electrical cardioversion. Although he was receiving oral baclofen when his pump failed, and he was given an intrathecal bolus of baclofen, he subsequently developed rhabdomyolysis, hepatic enzyme elevations, and a consumptive coagulopathy. Cerebral ischemia then occurred, causing brain death. The literature about intrathecal baclofen withdrawal is reviewed to illustrate that it can be a life-threatening event.