Tags

Type your tag names separated by a space and hit enter

Bladder stones - red herring for resurgence of spasticity in a spinal cord injury patient with implantation of Medtronic Synchromed pump for intrathecal delivery of baclofen - a case report.
BMC Urol. 2003 Mar 25; 3:3.BU

Abstract

BACKGROUND

Increased spasms in spinal cord injury (SCI) patients, whose spasticity was previously well controlled with intrathecal baclofen therapy, are due to (in order of frequency) drug tolerance, increased stimulus, low reservoir volume, catheter malfunction, disease progression, human error, and pump mechanical failure. We present a SCI patient, in whom bladder calculi acted as red herring for increased spasticity whereas the real cause was spontaneous extrusion of catheter from intrathecal space.

CASE PRESENTATION

A 44-year-old male sustained a fracture of C5/6 and incomplete tetraplegia at C-8 level. Medtronic Synchromed pump for intrathecal baclofen therapy was implanted 13 months later to control severe spasticity. The tip of catheter was placed at T-10 level. The initial dose of baclofen was 300 micrograms/day of baclofen, administered by a simple continuous infusion. During a nine-month period, he required increasing doses of baclofen (875 micrograms/day) to control spasticity. X-ray of abdomen showed multiple radio opaque shadows in the region of urinary bladder. No malfunction of the pump was detected. Therefore, increased spasticity was attributed to bladder stones. Electrohydraulic lithotripsy of bladder stones was carried out successfully. Even after removal of bladder stones, this patient required further increases in the dose of intrathecal baclofen (950, 1050, 1200 and then 1300 micrograms/day). Careful evaluation of pump-catheter system revealed that the catheter had extruded spontaneously and was lying in the paraspinal space at L-4, where the catheter had been anchored before it entered the subarachnoid space. A new catheter was passed into the subarachnoid space and the tip of catheter was located at T-8 level. The dose of intrathecal baclofen was decreased to 300 micrograms/day.

CONCLUSION

Vesical calculi acted as red herring for resurgence of spasticity. The real cause for increased spasms was spontaneous extrusion of whole length of catheter from subarachnoid space. Repeated bending forwards and straightening of torso for pressure relief and during transfers from wheel chair probably contributed to spontaneous extrusion of catheter from spinal canal in this patient.

Authors+Show Affiliations

Regional Spinal Injuries Centre, District General Hospital, Southport, PR8 6PN, UK. vaidyanathansiu@hotmail.comNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Case Reports
Journal Article

Language

eng

PubMed ID

12659647

Citation

Vaidyanathan, Subramanian, et al. "Bladder Stones - Red Herring for Resurgence of Spasticity in a Spinal Cord Injury Patient With Implantation of Medtronic Synchromed Pump for Intrathecal Delivery of Baclofen - a Case Report." BMC Urology, vol. 3, 2003, p. 3.
Vaidyanathan S, Soni BM, Oo T, et al. Bladder stones - red herring for resurgence of spasticity in a spinal cord injury patient with implantation of Medtronic Synchromed pump for intrathecal delivery of baclofen - a case report. BMC Urol. 2003;3:3.
Vaidyanathan, S., Soni, B. M., Oo, T., Hughes, P. L., Singh, G., Watt, J. W., & Sett, P. (2003). Bladder stones - red herring for resurgence of spasticity in a spinal cord injury patient with implantation of Medtronic Synchromed pump for intrathecal delivery of baclofen - a case report. BMC Urology, 3, 3.
Vaidyanathan S, et al. Bladder Stones - Red Herring for Resurgence of Spasticity in a Spinal Cord Injury Patient With Implantation of Medtronic Synchromed Pump for Intrathecal Delivery of Baclofen - a Case Report. BMC Urol. 2003 Mar 25;3:3. PubMed PMID: 12659647.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Bladder stones - red herring for resurgence of spasticity in a spinal cord injury patient with implantation of Medtronic Synchromed pump for intrathecal delivery of baclofen - a case report. AU - Vaidyanathan,Subramanian, AU - Soni,Bakul M, AU - Oo,Tun, AU - Hughes,Peter L, AU - Singh,Gurpreet, AU - Watt,John W H, AU - Sett,Pradipkumar, Y1 - 2003/03/25/ PY - 2003/01/16/received PY - 2003/03/25/accepted PY - 2003/3/28/pubmed PY - 2003/12/3/medline PY - 2003/3/28/entrez SP - 3 EP - 3 JF - BMC urology JO - BMC Urol VL - 3 N2 - BACKGROUND: Increased spasms in spinal cord injury (SCI) patients, whose spasticity was previously well controlled with intrathecal baclofen therapy, are due to (in order of frequency) drug tolerance, increased stimulus, low reservoir volume, catheter malfunction, disease progression, human error, and pump mechanical failure. We present a SCI patient, in whom bladder calculi acted as red herring for increased spasticity whereas the real cause was spontaneous extrusion of catheter from intrathecal space. CASE PRESENTATION: A 44-year-old male sustained a fracture of C5/6 and incomplete tetraplegia at C-8 level. Medtronic Synchromed pump for intrathecal baclofen therapy was implanted 13 months later to control severe spasticity. The tip of catheter was placed at T-10 level. The initial dose of baclofen was 300 micrograms/day of baclofen, administered by a simple continuous infusion. During a nine-month period, he required increasing doses of baclofen (875 micrograms/day) to control spasticity. X-ray of abdomen showed multiple radio opaque shadows in the region of urinary bladder. No malfunction of the pump was detected. Therefore, increased spasticity was attributed to bladder stones. Electrohydraulic lithotripsy of bladder stones was carried out successfully. Even after removal of bladder stones, this patient required further increases in the dose of intrathecal baclofen (950, 1050, 1200 and then 1300 micrograms/day). Careful evaluation of pump-catheter system revealed that the catheter had extruded spontaneously and was lying in the paraspinal space at L-4, where the catheter had been anchored before it entered the subarachnoid space. A new catheter was passed into the subarachnoid space and the tip of catheter was located at T-8 level. The dose of intrathecal baclofen was decreased to 300 micrograms/day. CONCLUSION: Vesical calculi acted as red herring for resurgence of spasticity. The real cause for increased spasms was spontaneous extrusion of whole length of catheter from subarachnoid space. Repeated bending forwards and straightening of torso for pressure relief and during transfers from wheel chair probably contributed to spontaneous extrusion of catheter from spinal canal in this patient. SN - 1471-2490 UR - https://www.unboundmedicine.com/medline/citation/12659647/Bladder_stones___red_herring_for_resurgence_of_spasticity_in_a_spinal_cord_injury_patient_with_implantation_of_Medtronic_Synchromed_pump_for_intrathecal_delivery_of_baclofen___a_case_report_ L2 - https://bmcurol.biomedcentral.com/articles/10.1186/1471-2490-3-3 DB - PRIME DP - Unbound Medicine ER -