![]() Over the course of 24 hours, the patient’s clinical condition did not improve and she continued to require BiPAP. Her neurological examination upon presentation to the MICU showed a somnolent patient with delayed responses to verbal commands and no verbal output beyond incomprehensible sounds. All medications that could be contributing to her diminished mental status continued to be held, including baclofen. Upon admission to the MICU, she was immediately started on bi-level positive airway pressure (BiPAP) due to hypoxia (SpO 2 ∼85%-90%) and a respiratory rate above 30 breaths per minute. She was on an extensive regimen of psychiatric and pain medications as an outpatient, which included promethazine, clonazepam, venlafaxine, modafinil, cyclobenzaprine, gabapentin, Ox圜ontin, oxycodone, and baclofen 20 mg by mouth 3 times daily. Her past medical history was significant for hypertension, obstructive sleep apnea, asthma, smoking, and chronic back pain. She was discharged to a skilled nursing and rehabilitation facility from VUMC, and because of her altered mentation there, she was moved to an outside hospital and then back to VUMC. Her postoperative course was complicated by wound dehiscence and multiple surgical site infections and the development of a paraspinal abscess requiring incision and drainage. ![]() The patient had been recently discharged 9 days earlier, following an admission for revision of T12-L2 laminectomy with hardware failure. Her husband reported to the medical resident that she had been experiencing visual hallucinations and altered mentation that was mostly inattention for approximately 3 days. This 62-year-old female was transferred to Vanderbilt University Medical Center (VUMC) Medical Intensive Care Unit (MICU) from an outside hospital secondary to her altered mental status and lower extremity weakness. The withdrawal from intrathecal baclofen is well described and understood clinically however, this case report helps emphasize that the withdrawal symptoms of oral baclofen can be clinically severe. We report a case of oral baclofen withdrawal developing alerted mental status and respiratory insufficiency. 4 Psychosis, delirium, and behavioral disturbances can arise abruptly with cessation of baclofen, and patients on chronic therapy are at highest risk. However, complete resolution of this delirium is possible with simple reinstatement of the patient’s baclofen. 4 In the Leo and Baer review, they state that baclofen-withdrawal delirium can be difficult to distinguish from delirium of other etiologies. 2, 3 There have been many published cases reporting psychological symptoms in association with baclofen withdrawal specifically, delirium arising secondary to abrupt baclofen cessation. Withdrawal from baclofen can have clinical manifestations that include agitation, insomnia, confusion, delusions, hallucinations, seizures, visual changes, psychosis, dyskinesia, hyperthermia, and increased spasticity. 3 The two routes of administration are oral and intrathecal. 1, 2 Spasticity can be an end point of a variety of neurological disorders when there is upper motor neuron damage. Baclofen is a gamma-aminobutyric acid (GABA) analog that has clinical indications to help treat spasticity and rigidity.
0 Comments
Leave a Reply. |
AuthorWrite something about yourself. No need to be fancy, just an overview. ArchivesCategories |